经锁骨下单孔免充气腔镜手术与传统开放手术治疗甲状腺乳头状癌的临床对比研究

Clinical comparative study of trans-subclavian gasless single-port endoscopic thyroidectomy and traditional open surgery in treatment of papillary thyroid carcinoma

目的:对比经锁骨下单孔免充气腔镜手术与传统开放甲状腺手术治疗甲状腺乳头状癌的临床疗效。方法:回顾分析2021年1月1日至2024年5月1日为308例甲状腺乳头状癌患者行手术治疗的临床资料。其中151例经锁骨下行单孔免充气腔镜甲状腺手术(腔镜组),157例行传统开放手术(开放组)。结果:两组患者性别、年龄、术前血清钙离子及甲状旁腺激素浓度、肿瘤最大径、中央区淋巴结清扫数量、喉返神经信号改变率差异无统计学意义(P>0.05)。腔镜组术后第1天甲状旁腺激素及血清钙离子浓度、术后60 d的美容满意度评分高于开放组,术后甲状旁腺功能减退及颈前区不适发生率低于开放组,手术时间、引流时间、术后住院时间长于开放组,术后引流量多于开放组,差异有统计学意义(P<0.05)。术后两组均未出现出血、切口感染、皮下血肿、颈部乳糜漏及皮瓣坏死等并发症。结论:与传统开放手术相比,经锁骨下单孔免充气腔镜甲状腺手术治疗甲状腺乳头状癌是可行的,可降低术后甲状旁腺功能减退发生率,术后手术疤痕隐蔽,美容及颈前区功能保护效果好,值得推广。

Objective:To compare the clinical efficacy between gasless trans-subclavian single-port endoscopic thyroidectomy and traditional open surgery in treatment of papillary thyroid carcinoma.Methods:The clinical data of 308 patients who suffered from papillary thyroid carcinoma and underwent radical thyroidectomy from Jan 1,2021 to May 1,2024 were retrospectively analyzed,including 151 cases of gasless trans-subclavian single-port endoscopic thyroidectomy(endoscopic group)and 157 cases of traditional open surgery(open group).Results:There were no significant differences in gender,age,preoperative levels of serum calcium and serum parathyroid hormone,maximum tumor diameter,harvested number of lymph nodes in the central compartment,and signal change rate of recurrent laryngeal nerve(P>0.05).The endoscopic group had higher levels of postoperative day 1 serum parathyroid hormone and s erum calcium,higher score of postoperative day 60 aesthetic satisfaction,lower incidence of postoperative hypoparathyroidism and anterior cervical discomfort,longer surgical time,postoperative drainage time and postoperative hospital stay,and more volume of postoperative drainage,and the differences were statistically significant(P<0.05).Postoperative complications such as hemorrhage,incisional i nfections,subcutaneous hematoma,chylous leakage in neck,and skin flap necrosis were not found in both groups.Conclusions:C ompared with traditional open surgery,gasless trans-subclavian single-port endoscopic thyroidectomy is feasible for the treatment of papillary thyroid carcinoma,and it may have more advantages in reducing the incidence of postoperative hypoparathyroidism.Moreover,this technique is worthy of clinical promotion for its well-concealed scar,good aesthetic effect and protection of the function of the anterior cervical region.