3种不同入路腔镜手术治疗甲状腺微小癌的疗效及并发症对比研究

Comparison of efficacy and complications of endoscopic surgery through three different approaches in the treatment of thyroid microcarcinoma

摘要:

目的 探究3种不同入路腔镜手术治疗甲状腺微小癌的疗效及并发症发生情况。方法 回顾性选取2020年1月至2023年3月于皖南医学院第一附属医院弋矶山医院接受腔镜手术治疗的240例甲状腺微小癌患者为对象，根据手术入路方式分为经口组（经口腔前庭入路，n=71）、经腋窝组（经腋窝入路，n=73）和经胸乳组（经胸乳入路，n=96）。比较各组一般临床资料、围术期指标，评估患者术后疼痛情况、切口美观度和患者满意度，记录术后并发症发生情况。结果 经腋窝组的手术时间明显短于经口组、经胸乳组（均P<0.001）；各组切口总长度比较：经口组<经胸乳组<经腋窝组（均P<0.001）；经口组中央区淋巴结清扫数量多于经腋窝组、经胸乳组，清扫时间短于经腋窝组、经胸乳组（均P<0.001）。术后6 h、12 h、24 h和48 h，经口组、经腋窝组的视觉模拟评分（visual analogue scale，VAS）均小于经胸乳组（均P<0.001）。经口组、经腋窝组的切口美观度、患者满意度评分均明显高于经胸乳组（均P<0.001）。3组患者并发症总发生率比较，差异无统计学意义（P=0.491）。结论 3种入路腔镜手术治疗甲状腺微小癌的临床疗效相当，术后并发症无差别，但经腋窝入路手术时间最短，经口腔前庭入路清除中央区淋巴结效果更好，用时更短，在保证疗效的同时，美容效果更佳，临床可根据患者实际情况选择合适的入路方式。

Abstract:

Objective To investigate the efficacy and complications of endoscopic surgery through three different approaches in the treatment of thyroid microcarcinoma.Methods We retrospectively included 240 patients with thyroid microcarcinoma who had undergone endoscopic surgery in The Second Affiliated Hospital of Wannan Medical College from January 2020 to March 2023. According to surgical approaches，the patients were divided into transoral vestibular approach group（n=71），transaxillary approach group（n=73）， and breast approach group（n=96）. The three groups were comparted in terms of general clinical data， perioperative indicators，postoperative pain，incision aesthetics，patients’ degree of satisfaction， and postoperative complications.Results The operation time of the transaxillary group was significantly shorter than that of the other two groups（P<0.001）. The length of incision was significantly different between the three groups： the transoral group < the breast group < the transaxillary group（P<0.001）. The transoral group had a significantly greater number of dissected central lymph nodes and a significantly shorter dissection time compared with the other two groups（P<0.001）. The visual analogue scale score was significantly lower in the transoral and transaxillary groups than in the breast group at 6 h，12 h，24 h，and 48 h after operation（P<0.001）. The transoral group and the transaxillary group were significantly superior to the breast group in incision aesthetics and patients’ degree of satisfaction（P<0.001）. The overall incidence of complications showed no significant difference between the three groups（P=0.491）.Conclusion Endoscopic surgery through the three approaches were equivalently effective in the treatment of thyroid microcarcinoma， with no difference in complications. However，the transaxillary approach showed the shortest operation time， and the transoral vestibular approach was superior in central lymph node dissection， dissection time， and incision aesthetics while ensuring the effectiveness. Surgical approach selection should be based on patient’s actual condition.