3种不同入路腔镜手术治疗甲状腺微小癌的疗效及并发症对比研究

Comparison of efficacy and complications of endoscopic surgery through three different approaches in the treatment of thyroid microcarcinoma

目的:探究3种不同入路腔镜手术治疗甲状腺微小癌的疗效及并发症发生情况。方法:回顾性选取2020年1月至2023年3月于皖南医学院第一附属医院弋矶山医院接受腔镜手术治疗的240例甲状腺微小癌患者为对象,根据手术入路方式分为经口组(经口腔前庭入路,n=71)、经腋窝组(经腋窝入路,n=73)和经胸乳组(经胸乳入路,n=96)。比较各组一般临床资料、围术期指标,评估患者术后疼痛情况、切口美观度和患者满意度,记录术后并发症发生情况。结果:经腋窝组的手术时间明显短于经口组、经胸乳组(均P<0.001);各组切口总长度比较:经口组<经胸乳组<经腋窝组(均P<0.001);经口组中央区淋巴结清扫数量多于经腋窝组、经胸乳组,清扫时间短于经腋窝组、经胸乳组(均P<0.001)。术后6 h、12 h、24 h和48 h,经口组、经腋窝组的视觉模拟评分(visual analogue scale,VAS)均小于经胸乳组(均P<0.001)。经口组、经腋窝组的切口美观度、患者满意度评分均明显高于经胸乳组(均P<0.001)。3组患者并发症总发生率比较,差异无统计学意义(P=0.491)。结论:3种入路腔镜手术治疗甲状腺微小癌的临床疗效相当,术后并发症无差别,但经腋窝入路手术时间最短,经口腔前庭入路清除中央区淋巴结效果更好,用时更短,在保证疗效的同时,美容效果更佳,临床可根据患者实际情况选择合适的入路方式。

Objective:To investigate the efficacy and complications of endoscopic surgery through three different approaches in the treatment of thyroid microcarcinoma.Methods:We retrospectively included 240 patients with thyroid microcarcinoma who had under-gone endoscopic surgery in The Second Affiliated Hospital of Wannan Medical College from January 2020 to March 2023.According to surgical approaches,the patients were divided into transoral vestibular approach group(n=71),transaxillary approach group(n=73),and breast approach group(n=96).The three groups were comparted in terms of general clinical data,perioperative indicators,postop-erative pain,incision aesthetics,patients’degree of satisfaction,and postoperative complications.Results:The operation time of the transaxillary group was significantly shorter than that of the other two groups(P<0.001).The length of incision was significantly differ-ent between the three groups:the transoral group<the breast group<the transaxillary group(P<0.001).The transoral group had a sig-nificantly greater number of dissected central lymph nodes and a significantly shorter dissection time compared with the other two groups(P<0.001).The visual analogue scale score was significantly lower in the transoral and transaxillary groups than in the breast group at 6 h,12 h,24 h,and 48 h after operation(P<0.001).The transoral group and the transaxillary group were significantly superior to the breast group in incision aesthetics and patients’degree of satisfaction(P<0.001).The overall incidence of complications showed no significant difference between the three groups(P=0.491).Conclusion:Endoscopic surgery through the three approaches were equivalently effective in the treatment of thyroid microcarcinoma,with no difference in complications.However,the transaxillary ap-proach showed the shortest operation time,and the transoral vestibular approach was superior in central lymph node dissection,dissec-tion time,and incision aesthetics while ensuring the effectiveness.Surgical approach selection should be based on patient’s actual con-dition.