经口前庭入路腔镜下早期甲状腺癌根治术的临床研究

Clinical study of early-stage thyroid cancer radical resection by transoral vestibular approach

目的 分析经口前庭入路腔镜下早期甲状腺癌根治术(transoral endascopic thyroidectomy,TOET)的临床效果。方法 选取2019年1月—2021年1月九江市第一人民医院适合腔镜手术且病理确诊分化型甲状腺癌(直径≤2 cm)的50例患者,按照手术方式的不同分成观察组和对照组,每组25例。对照组进行传统开放式手术,观察组采用经口腔前庭入路腔镜下早期甲状腺癌根治术,对比2组治疗效果。结果 观察组缓解率高于对照组,观察组的手术时间、住院时间短于对照组,术中出血量少于对照组,观察组的中央区淋巴结清扫数量多于对照组,差异有统计学意义(P<0.05)。2组并发症发生率比较差异无统计学意义(P>0.05)。术前,2组C-反应蛋白(C-reactive protein,CRP)、皮质醇(cortisol,Cor)水平比较,差异无统计学意义(P>0.05);术后,2组的CRP均高于术前,但观察组CRP低于对照组(P<0.05),2组Cor水平均低于术前(P<0.05),差异无统计学意义(P>0.05)。术后第1天和第3天观察组视觉模拟评分(visual analogue scale,VAS)低于对照组,差异有统计学意义(P<0.05)。观察组切口满意度显著高于对照组(P<0.05)。结论 TOET安全有效,切口外观满意度高,能减少患者的疼痛和应激反应,整体效果良好,值得推广。

Objective To analyze the clinical effect of transoral vestibular approach endoscopic radical thyroidectomy(TOET).Methods From January 2019 to January 2021,50 patients with differentiated thyroid cancer(diameter≤2 cm)who were suitable for endoscopic surgery and pathologically diagnosed in Jiujiang First People's Hospital were selected and divided into observation group and control group according to different surgical methods,with 25 cases.The control group underwent traditional open surgery,while the observation group underwent endoscopic surgery through the oral vestibular approach.The treatment effects of the two groups were compared.Results The remission rate of the observation group was higher than that of the control group,the operation time and hospital stay of the observation group were shorter than those of the control group,the amount of intraoperative bleeding was less than that of the control group,and the number of lymph node dissection in the central area of the observation group was more than that of the control group(P<0.05).There was no significant difference in the complication rate between the two groups(P>0.05).Before operation,there was no significant difference in CRP and cor between the two groups(P>0.05).After operation,CRP in both groups was higher than that before operation,CRP in the observation group was lower than that in the control group(P<0.05),and the level of cor in both groups was lower than that before operation(P<0.05).The VAS score of the observation group was significantly lower than that of the control group at 1d and 3d after operation(P<0.05).The incision satisfaction of the observation group was significantly higher than that of the control group(P<0.05).Conclusion TOET is safe and effective,with high satisfaction with the appearance of the incision,reducing pain and stress response,and the overall effect is good,which is worthy of promotion.