经乳晕入路与无充气腋窝入路腔镜手术治疗甲状腺乳头状癌患者的临床效果观察

Clinical observation of areola approach endoscopic thyroidectomy and gasless axillary approach endoscopic thyroidectomy in the treatment of patients with papillary thyroid carcinoma

目的探讨经乳晕入路腔镜甲状腺手术(areola approach endoscopic thyroidectomy,AET)与无充气腋窝入路腔镜甲状腺手术(gasless axillary approach endoscopic thyroidectomy,GAET)治疗甲状腺乳头状癌(papillary thyroid carcinoma,PTC)患者的临床效果。方法选取2019年5月至2022年5月临沂市人民医院甲状腺外科PTC患者96例,按照随机数字表法分为乳晕组(采取AET)和腋窝组(采取GAET),各48例。比较两组手术情况、术后恢复情况、手术前后相关生化指标[白细胞计数(white blood cell count,WBC)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)、甲状旁腺素(parathyroid hormone,PTH)、血钙]水平、术后疼痛程度、不适感程度、颈部功能及并发症。结果腋窝组手术时间、拔管时间分别为(125.71±15.73)min、(3.12±0.53)d,均短于乳晕组的(137.94±20.02)min、(3.48±0.46)d;术中出血量为(14.19±4.16)mL,少于乳晕组的(22.65±7.39)mL;清扫淋巴结为(5.06±1.02)个,多于乳晕组的(4.23±1.14)个(P<0.05);两组术后引流量、住院时间差异无统计学意义(P>0.05)。腋窝组术后1d及3d外周血WBC为(5.69±0.15)、(5.52±0.14)×10^(9)/L,ESR为(8.21±0.55)(7.64±0.60)mm/h,CRP为(10.06±1.78)、(8.93±1.33)ng/L,低于乳晕组的(5.83±0.21)、(5.70±0.23)×10^(9)/L,(8.87±0.74)、(8.19±0.68)mm/h,(12.45±1.90)、(10.45±1.50)ng/L(P<0.05),术后5d上述生化指标水平差异无统计学意义(P>0.05)。两组术后1d、3d及5d外周血PTH、血钙水平差异无统计学意义(P>0.05)。腋窝组术后1d、3d及5d疼痛程度为(3.25±0.32)、(2.53±0.27)、(1.82±0.22)分,不适感程度为(6.85±0.71)、(5.24±0.66)、(3.51±0.57)分,低于乳晕组的(3.78±0.40)、(2.89±0.34)、(2.06±0.26)、(7.46±0.84)、(6.09±0.73)、(4.16±0.60)分(P<0.05)。腋窝组术后3d颈部前屈、侧屈、后伸活动度分别为(33.16±3.09)、(27.63±2.57)°、(30.44±2.73)°均大于乳晕组的(30.08±2.76)°、(25.14±2.30)°、(27.98±2.54)°;吞咽障碍指数为(30.16±4.97)分,小于乳晕组的(34.83±4.13)分(P<0.05);腋窝组并发症发生率为4.17%(2/48),低于乳晕组的16.67%(8/48)。结论GAET治疗PTC患者能提高清扫淋巴结效果,减轻手术创伤程度、术后疼痛感及不适感,还能加快术后早期颈部功能恢复,减少并发症。

Objective To explore the clinical efficacy of areola approach endoscopic thyroidectomy(AET)and gasless axillary approach endoscopic thyroidectomy(GAET)in the treatment of papillary thyroid carci-noma(PTC)patients.Methods A total of 96 PTC patients from the Thyroid Surgery Department of Linyi People s Hospital from May.2019 to May.2022 were selected and randomly divided into 48 patients using a random num-ber table method.The areola group received AET,while the armpit group received GAET.The surgical situation,postoperative recovery,relevant biochemical indicators[white blood cell count(WBC),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),parathyroid hormone(PTH),blood calciuml before and after surgery,post-operative pain level,discomfort level,neck function,and complications were compared between the two groups.Results The surgical time and extubation time of the armpit group were(125.71±15.73)minutes and(3.12±0.53)days,respectively,which were shorter than those of the areola group(137.94±20.02)minutes and(3.48±0.46)days.The intraoperative bleeding volume was(14.19±4.16)mL,which was less than that of the areola group(22.65±7.39)mL,and the number of lymph nodes cleaned was 5.06±1.02,which was more than that of the areola group(4.23±1.14)(P<0.05);there was no significant difference in postoperative drainage volume and hospital stay between the two groups(P>0.05);Peripheral blood WBC in the armpit group on the lst and 3rd day after surgery[(5.69±0.15)×10^(9)/L,(5.52±0.14)]×10^(9)/L,ESR[(8.21±0.55)mm/h,(7.64±0.60)mm/h],CRP[(10.06±1.78)ng/L,(8.93±1.33)ng/L)were lower than those in the areola group[(5.83±0.21)×10^(9)/L,(5.70±0.23)×10^(9)/L,(8.87±0.74)mm/h,(8.19±0.68)mm/h,(12.45±1.90)ng/L,(10.45±1.50)ng/L](P<0.05).There was no significant difference in the levels of the above biochemical indicators 5 days after surgery(P>0.05).There was no significant difference in peripheral blood PTH and calcium levels between the two groups on the Ist,3rd,and 5th postoperative days(P>0.05).The pain level[(3.25±0.32)scores,(2.53±0.27)scores,(1.82±0.22)scores]and discomfort level[(6.85±0.71)scores,(5.24±0.66)scores,(3.51±0.57)scores]in the axillary group were lower than those in the areola group[(3.78±0.40)scores,(2.89±0.34)scores,(2.06±0.26)scores,(7.46±0.84)scores,(6.09±0.73)scores,(4.16±0.60)scoresl on the 1st,3rd,and 5th postoperative days(P<0.05).The neck flexion,lateral flexion,and extension range of motion in the axillary group on the 3rd day after surgery were(33.16±3.09)°,(27.63±2.57)°,and(30.442.73)°,respectively,which were greater than those in the areola group[(30.08±2.76)°,(25.14±2.30)°,and(27.98±2.54)°],and the swallowing disorder index was(30.16±4.97)points lower than the(34.83±4.13)points in the areola group(P<0.05).The incidence of complications in the axillary group was 4.17%(2/48),lower than the 16.67%(8/48)in the areola group.Conclusion GAET treatment for PTC patients can improve the effect of lymph node dissection,reduce the degree of surgical trauma,postoperative pain and discomfort,accelerate early postoperative recovery of neck function,and reduce complications.