腋窝入路无充气腔镜手术与开放性甲状腺癌根治术对甲状腺癌患者颈部功能的影响分析

Effect analysis of endoscopic surgery via gasless transaxillary approach and open radical thyroidectomy on cervical function in patients with thyroid cancer

目的分析对甲状腺癌患者采用腋窝入路无充气腔镜手术与开放性甲状腺癌根治术的临床疗效及对其颈部功能的影响。方法70例甲状腺癌患者,采用随机数字表法分为观察组和对照组,每组35例。观察组行腋窝入路无充气腔镜手术,对照组行开放性甲状腺癌根治术。对比两组围术期指标、颈部功能及免疫功能。结果观察组手术时间(125.17±8.55)min及住院时间(6.58±0.88)d长于对照组的(75.59±7.18)min、(5.39±0.58)d,术中出血量(19.41±2.55)ml少于对照组的(33.18±3.59)ml,引流液总量(90.39±5.66)ml多于对照组的(53.29±6.87)ml(P<0.05);两组中央组淋巴结清扫数对比差异无统计学意义(P>0.05)。两组术后3 d及术后半年颈部疼痛评分、颈部损伤指数对比差异无统计学意义(P>0.05)。两组术后3 d吞咽障碍指数对比差异无统计学意义(P>0.05);观察组术后半年吞咽障碍指数(1.29±0.17)分低于对照组的(1.79±0.33)分(P<0.05)。观察组术后CD3+(67.79±5.18)%、CD4+(40.11±5.12)%高于对照组的(59.49±5.09)%、(36.34±5.11)%,CD8+(27.67±4.69)%低于对照组的(32.21±5.22)%(P<0.05)。结论对甲状腺癌患者采用腋窝入路无充气腔镜手术能减轻其免疫抑制,与开放性甲状腺癌根治术相比具有缓解患者吞咽障碍的优势。

Objective To analyze the clinical efficacy of endoscopic surgery via gasless transaxillary approach and open radical thyroidectomy in patients with thyroid cancer and its influence on their cervical function.Methods 70 patients with thyroid cancer were divided into an observation group and a control group by random number table method,with 35 cases in each group.The observation group underwent endoscopic surgery via gasless transaxillary approach,and the control group underwent open radical thyroidectomy.The perioperative indexes,cervical function and immune function were compared between the two groups.Results The operation time of(125.17±8.55)min and hospitalization time of(6.58±0.88)d in the observation group were longer than(75.59±7.18)min and(5.39±0.58)d in the control group;the intraoperative blood loss of(19.41±2.55)ml in the observation group was less than(33.18±3.59)ml in the control group;the total amount of drainage fluid of(90.39±5.66)ml in the observation group was more than(53.29±6.87)ml in the control group(P<0.05).There was no significant difference in the number of lymph node dissection between the two groups(P>0.05).There was no significant difference in neck pain score and neck injury index at 3 d and 6 months after surgery between the two groups(P>0.05).There was no significant difference in dysphagia index between the two groups at 3 d after surgery(P>0.05).At half-year after surgery,the dysphagia index of(1.29±0.17)points in the observation group was lower than(1.79±0.33)points in the control group(P<0.05).The observation group had CD3+of(67.79±5.18)%and CD4+of(40.11±5.12)%,which were higher than(59.49±5.09)%and(36.34±5.11)%in the control group;and CD8+of(27.67±4.69)%was lower than(32.21±5.22)%in the control group(P<0.05).Conclusion Endoscopic surgery via gasless transaxillary approach can reduce immunosuppression in patients with thyroid cancer,and has the advantage of alleviating swallowing disorders compared with open radical thyroidectomy.