经口入路与经胸入路腔镜手术治疗单侧甲状腺癌的疗效比较

Comparison of efficacy between transoral and transthoracic endoscopic surgery for unilateral thyroid cancer

目的探讨经口入路与经胸入路腔镜手术治疗单侧甲状腺癌的临床疗效。方法本研究为回顾性研究。依据纳入与排除标准,搜集2018年1月—2023年5月行腔镜下甲状腺癌根治术的128例患者的病例资料为研究对象。按照手术入路方式分为经胸入路组(经胸入路、胸乳入路、全乳晕入路)23例、经口入路组(经口入路、颏下口腔前庭联合入路)105例,比较两组患者的基线资料、肿瘤最大径、合并桥本甲状腺炎、肿瘤单发与多发、手术时间、术后住院时间,以及中央区淋巴结(CLN)清扫与转移数目、术后并发症等疗效指标。符合正态分布的计量资料以xˉ±s表示、采用t检验,不符合者以M(Q_(1),Q_(3))表示、采用Mann-Whitney U检验;计数资料以频数(%)表示、采用χ^(2)检验。结果两组患者的年龄、性别、肿瘤最大径、BMI、合并桥本甲状腺炎占比比较,差异均无统计学意义(P均>0.05);经胸入路组患者的手术时间明显短于经口入路组、术后住院时间明显长于经口入路组、CLN清扫数目少于经口入路组,差异均有统计学意义(P均<0.05);两组患者的肿瘤单发与多发、CLN转移数目及术后并发症发生率比较,差异均无统计学意义(P均>0.05)。随访6个月后,经口入路组2例并发症中,1例患侧颈侧区发生淋巴结转移,再次手术治疗后好转;1例左侧口腔内戳卡孔处感染,经抗感染治疗后好转;其他患者无复发、转移情况,均对切口满意。结论经口入路与经胸入路腔镜手术治疗甲状腺癌患者的效果相当,经口入路在淋巴结清扫方面更具优势。

Objective To investigate the clinical efficacy of transoral versus transthoracic endoscopic surgery in the treatment of unilateral thyroid cancer.Methods The case data of 128 patients who underwent laparoscopic radical surgery for unilateral thyroid cancer from January 2018 to May 2023 were collected as the study subjects in this retrospective study.According to the surgical approaches,patients were divided into the transthoracic group(transthoracic approach,chest-breast approach,complete areola approach,23 cases)and the transoral group(transoral approach,submental oral vestibular combined approach,105 cases).Baseline data,maximum tumor diameter,presence of Hashimoto's thyroiditis,solitary or multiple tumors,operation time,postoperative hospital stay,the number of central lymph nodes(CLN)dissected and metastasized,and postoperative complications were compared between the two groups.Normally distributed measurements data were expressed as xˉ±s using the t-test.Non-normally distributed data were expressed as M(Q_(1),Q_(3))and analyzed using the Mann-Whitney U-test.Count data were expressed as frequency(%)and analyzed using theχ^(2) test.Results There was no statistically significant differences between the two groups in age,gender,maximum tumor diameter,BMI,and the proportion of patients with Hashimoto's thyroiditis(all P>0.05).The operation time in the transthoracic group was significantly shorter than that in the transoral group,the postoperative hospital stay was significantly longer in the transthoracic group,and the number of CLNs dissected was less in the transthoracic group,with all differences being statistically significant(all P<0.05).There were no statistically significant differences between the two groups in the number and CLN metastases,and the incidence of postoperative complications(all P>0.05).After 6 months of follow-up,among the two cases with complications in the transoral group,one case had lymph node metastasis in the ipsilateral neck and improved after another surgery,and one case had an infection at the puncture site in the left oral cavity which improved after anti-infection treatment.No recurrence or metastasis was observed in other patients,and all were satisfied with the incision.Conclusions The efficacy of transoral and transthoracic endoscopic surgery in the treatment of thyroid cancer is comparable,with the transoral approach offering advantages in lymph node dissection.