腔镜与开放手术治疗低危型甲状腺乳头状癌的疗效比较:附538例报告  

Efficacy comparison of laparoscopic and open surgery for low-risk papillary thyroid carcinoma: a report of 538 cases

作　　者：丁科 黄江生[1] 汪明明[1] 宫毅[1] 周钧[1] 段伦喜[1] DING Ke;HUANG Jiangsheng;WANG Mingming;GONG Yi;ZHOU Jun;DUAN Lunxi(Department of General Surgery, the Second Xiangya Hospital, Central South University, Changsha 410011, China)

机构地区：[1]中南大学湘雅二医院普通外科,湖南长沙410011

出　　处：《中国普通外科杂志》2019年第5期524-531,共8页China Journal of General Surgery

摘　　要：目的:比较腔镜与开放手术治疗低危型甲状腺乳头状癌患者的疗效,为低危型甲状腺乳头状癌的治疗方法的选择提供给参考。方法:回顾性分析中南大学湘雅二医院2010年11月—2015年11月手术治疗的538例低危型甲状腺乳头状癌患者的临床资料,其中243例行腔镜手术(腔镜组),295例行开放手术(开放组),比较两组患者的相关临床指标。结果:两组患者一般资料差异无统计学意义(均P>0.05)。无论是总体比较还是按切除范围分层比较,两组在手术时间、术中出血量、术后引流量、中央区淋巴结清扫数目、拔管时间、住院时间方面均无统计学差异(均P>0.05)。两组在术后出血、声音嘶哑、皮下血肿、饮水呛咳、低钙抽搐、伤口感染的发生率均统计学差异(P>0.05),腔镜组术后颈部不适发生率明显低于开放组(P<0.05)。两组术后第1、2、3天进行疼痛评分,以及术后3年存活率及复发率差异均无统计学意义(均P>0.05)。腔镜组术后美容效果等级评分明显优于开放组(均P<0.05)。结论:腔镜手术治疗低危型甲状腺乳头状癌是安全有效的,且相对传统开放手术能降低颈部不适感,美容效果上更能符合患者需求,可以考虑作为低危型甲状腺乳头状癌的首选手术方式。Objective: To compare the efficacy of laparoscopic and open surgery in treatment of low-risk thyroid papillary carcinoma, so as to provide reference for its treatment method selection. Methods: The clinical data of 538 patients with low-risk thyroid papillary carcinoma undergoing surgical treatment in the Second Xiangya Hospital of Central South University from November 2010 to November 2015 were retrospectively analyzed. Of the patients, 243 cases underwent laparoscopic thyroidectomy (laparoscopic group) and 295 cases underwent open thyroidectomy (open surgery group). The main clinical variables were compared between the two groups of patients. Results: There were no significant differences in terms of general data between the two groups (all P>0.05). No significant differences were observed in operative time, intraoperative blood loss, amount of postoperative drainage, number of retrieved lymph nodes in the central compartment, time to tube removal, and length of hospitalization between the two groups either by overall comparison or stratified comparison according to the resection scope (all P>0.05). No significant differences were noted in respect of the incidence of postoperative bleeding, hoarseness, subcutaneous hematoma, coughing when drinking water, hypocalcemic tetany and wound infection (all P>0.05), but the incidence of postoperative neck discomfort in laparoscopic group was significantly lower than that in open surgery group (P<0.05). The pain scores on postoperative day 1, 2, and 3, and the 3-year survival rate and recurrence rate all showed no significant differences between the two groups (all P>0.05). The postoperative cosmetic grading scores in laparoscopic group were significantly superior to those in open surgery group (all P<0.05). Conclusion: Laparoscopic surgery is safe and effective for the treatment of low-risk papillary thyroid carcinoma, and it can reduce the discomfort in the neck, and better meet the cosmetic requirements of the patients compared to traditional open surgery. It can be

关 键 词：甲状腺肿瘤 癌 乳头状 甲状腺切除术 疗效比较研究 

分 类 号：R736.1[医药卫生—肿瘤]