经口腔入路腔镜甲状腺肿瘤切除术治疗甲状腺微小乳头状癌患者的优势基于血清甲状旁腺功能和免疫功能

The Advantages of Endoscopic Thyroidectomy Through Oral Approach for the Treatment of Patients with Papillary Thyroid Carcinoma Are Based on Serum Parathyroid Function and Immune Function

目的探讨基于甲状旁腺功能和免疫功能经口腔入路腔镜甲状腺肿瘤切除术治疗甲状腺微小乳头状癌患者的优势。方法收集2022年2月—2023年4月在南阳市中心医院治疗的甲状腺微小乳头状癌患者90例,随机分为观察组(经口腔前庭入路腔镜手术,n=45)和对照组(颈部开放手术,n=45),分别对比两组患者手术总时长、术中失血量、术后引流量、疼痛评分、甲状旁腺功能和免疫功能指标以及两组患者的并发症发生率。结果观察组的手术总时长明显长于对照组,但术中失血量、术后引流量和疼痛评分均显著优于对照组(P<0.05)。在甲状旁腺功能方面,两组患者的甲状旁腺激素(PTH)和血清钙离子水平在手术后均有不同程度的下降,但观察组患者的PTH水平下降的程度更为轻微,差异具有统计学意义(P<0.05)。在免疫功能指标方面,手术前,两组患者的IgG和IgA水平差异无统计学意义(P>0.05),手术后观察组患者的IgG和IgA水平明显高于对照组患者,差异有统计学意义(P<0.05)。观察组患者的并发症发生率明显低于对照组患者(P<0.05)。结论相对于颈部开放手术,经口腔入路腔镜手术在治疗甲状腺微小乳头状癌方面具有明显的优势。经口腔入路腔镜手术创伤小、手术效果好、术后恢复快,且对甲状旁腺功能和免疫功能的影响更为轻微。因此,经口腔入路腔镜手术可以作为治疗甲状腺微小乳头状癌的首选方法之一。

Objective To explore the advantages of oral endoscopic thyroidectomy based on parathyroid function and immune function in the treatment of patients with papillary thyroid carcinoma.Methods 90 patients with papillary thyroid carcinoma treated in Nanyang Central Hospital from February 2022 to April 2023 were collected and randomly divided into observation group(oral vestibular endoscopic surgery,n=45)and control group(neck open surgery,n=45).The total surgical duration,intraoperative blood loss,postoperative drainage volume,pain score,parathyroid and immune function indicators,as well as the incidence of complications in the two groups of patients were compared.Results The total surgical duration of the observation group was significantly longer than that of the control group,but intraoperative blood loss,postoperative drainage volume,and pain score were significantly better than those of the control group(P<0.05).In terms of parathyroid function,the levels of parathyroid hormone(PTH)and serum calcium ions in both groups of patients decreased to varying degrees after surgery,but the observation group had a milder decrease in PTH levels,with statistical significance(P<0.05).In terms of immune function indicators,there was no significant difference in the levels of IgG and IgA between the two groups of patients before surgery(P>0.05).The levels of IgG and IgA in the observation after surgery were significantly higher than those in the comtrol group,and the difference was statistically significant(P<0.05).The incidence of complications in the observation group was significantly lower than that in the control group(P<0.05).Conclusion Compared to open neck surgery,endoscopic surgery via oral approach has significant advantages in the treatment of papillary thyroid carcinoma.Endoscopic surgery via oral approach has the advantages of minimal trauma,good surgical results,and fast postoperative recovery,and has a milder impact on parathyroid and immune function.Therefore,endoscopic surgery via oral approach can be one of the preferred methods for treating papillary thyroid carcinoma.