甲状腺癌改良腋乳入路腔镜手术应用研究  

Endoscopic thyroidectomy via modified axillo-breast approach for the treatment of thyroid carcinoma

作　　者：赵明[1] 谭卓[1] 王可敬[1] 赏金标[1] 郑传铭[1] 梁忠[1] ZHAO Ming;TAN Zhuo;WANG Ke-jing;SHANG Jin-biao;ZHENG Chuan-ming;LIANG Zhong(Department of Head and Neck Surgery, Zhej iang Cancer Hospital, Hangzhou 310022,P. R. China)

机构地区：[1]浙江省肿瘤医院头颈外科,浙江杭州310022

出　　处：《中华肿瘤防治杂志》2018年第10期730-733,共4页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的随着甲状腺腔镜手术的不断成熟,手术的入路方式仍在不断探索。本研究拟探讨改良腋乳入路腔镜手术对比胸乳入路手术在甲状腺癌治疗中的优缺点。方法收集2012-06-01-2015-06-01浙江省肿瘤医院收治的甲状腺癌患者96例,采用完全腔镜下手术,将其随机分为改良腋乳入路组50例(改良腋乳组),胸乳入路组46例(胸乳组)。比较两组的手术时间、术中出血量、术后引流量、拔管时间、清除淋巴结数目、术后甲状腺有无残留、术后并发症及患者的满意度。结果改良腋乳组与胸乳组手术时间分别为(73.9±8.2)、(85.5±9.7)min,t=6.389,P<0.05;术中出血量分别为(20±9)、(22±12)mL,t=0.710,P=0.479;术后引流量分别为(67±5)、(141±77)mL,t=5.908,P<0.05;拔管时间分别为(3.8±1.3)、(5.0±1.2)d,t=4.578,P<0.05;清除淋巴结数目分别为(2.7±1.7)、(3.1±2.6),t=0.908,P=0.366,差异均有统计学意义。两组术侧均无甲状腺残留、皮肤瘀斑及皮下气肿,患者的满意度分别为98%和83%,差异有统计学意义,P<0.05。结论改良腋乳入路相比胸乳入路具有手术时间短,术后引流液少,拔管时间短,皮肤瘀斑及皮下气肿轻,患者满意度高等优点。改良腋乳入路手术值得在单侧甲状腺癌全腔镜手术中应用。OBJECTIVE With the denelopoment of endoccopic thyroid surgery,various surgical approaches are emerging.The aim of this study was to evaluate and compare the surgical outcomes of Endoscopic thyroidectomy（ET）via modified axillo-breast approach and breast approach.METHODS Totally 96 patients who underwent unilateral lobectomy with central lymph node dissection for papillary thyroid carcinoma from June 1 2012 to June 1 2015 at Zhejiang Cancer Hospital were analyzed.Fifty patients underwent ET via modified axillo-breast approach（MABA group）and 46 patients via breast approach（BA group）.Surgical outcomes,including operation time,intraoperative blood lose,amount of postoperative drainage,number of dissected lymph nodes,postoperative residual thyroid,postoperative complication rate and patients＇ satisfaction were compared between these two groups.RESULTS The operation time was shorter in the MABA group（73.9±8.2）min than that in the BA group（85.5±9.7）min,（t=6.389,P〈0.05）.Postoperative drainage[（67±5）mL,（141±77）mL,t=5.908,P〈0.05）]and drainage tube removal time[（3.8±1.3）d,（5.0±1.2）d,t=4.578,P〈0.05）]in MABA group and BA group were significantly different.There were no significant differences in number of dissected lymph nodes（2.7±1.7,3.1±2.6,t=0.908,P=0.366）,intraoperative blood lose[（20±9）mL,（22±12）mL,t=0.710,P=0.479）]and postoperative complication,except subcutaneous ecchymosis（2 vs 10,P〈0.05）.Totally 49 patients were satisfied with the cosmetic result in the MABA group,and 38 patients were satisfied in the BA group（98% vs 83%,P〈0.05）.CONCLUSIONS Compared to BA group,MABA group had shorter operation time,shorter drainage tube removal time,less postoperative drainage,fewer complications and more satisfaction.ET via modified axillo-breast approach is a good choice for unilateral lobectomy with central lymph node dissection of PTC,which is worth to be popularized.

关 键 词：改良腋乳入路 胸乳入路 甲状腺癌 并发症 

分 类 号：R736.1[医药卫生—肿瘤]