胸乳径路甲状腺微小乳头状癌根治术与开放手术的临床对比分析  

Clinical comparative study of radical operation via the breast-thoracic approach and the open surgery for papillary thyroid microcarcinoma

作　　者：谢盼 杜友红 彭福森[1] 张艳红[1] 谭孟婷 XIE Pan;DU Youhong;PENG Fusen;ZHANG Yanhong;TAN Mengting(Department of Otolaryngology Head and Neck Surgery,Center Hospital of Loudi City,Loudi 417000,China)

机构地区：[1]娄底市中心医院耳鼻咽喉头颈外科,湖南娄底417000

出　　处：《中国耳鼻咽喉颅底外科杂志》2020年第4期452-455,共4页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：2017年中央引导地方科技发展专项(2017CT5208);娄底市科技计划项目(娄财教指[2017]58号)。

摘　　要：目的本文通过胸乳径路下甲状腺微小乳头状癌(PTMC)根治术与开放手术的临床对比研究,以探讨胸乳径路下PTMC根治术的安全性、可行性和实用性。方法收集2016年9月—2017年10月经治的43例经胸乳径路下PTMC根治术患者(胸乳组)及59例开放手术患者(开放组),对比分析两组患者在术中及术后的相关指标。结果胸乳组手术时间、住院时间比开放组长,术后第1天的切口引流量较开放组多(P<0.05),但胸乳组术后美容满意度优于开放组,特别是胸乳组5级评分中非常满意及满意的患者占88.37%,明显高于开放组的18.64%(P<0.05)。胸乳组43例患者术中出血量、术后24 h内VAS评分、总中央淋巴结清扫数目,阳性淋巴结清扫数目、术后喉返神经及甲状旁腺误伤率与开放组比较差异无统计学意义(P>0.05)。两组患者术后平均随访半年,均未见复发及转移。结论胸乳径路下PTMC根治术虽然术后引流量多、手术时间及住院时间较长,但美容效果十分突出,临床实践安全可行,具有广阔的应用前景;应在严格把握适应证及术者能熟练操作的基础上施行该手术。Objective To investigate the safety,feasibility and practicability of radical operation via the areola of breast approach compared to the open surgery for papillary thyroid microcarcinoma(PTMC).Methods A total of 43 patients undergoing radical PTMC surgery via the thoracic approach(the chest group)and 59 patients undergoing open surgery(the open group)were collected from September 2016 to October 2017,which were compared to analyze the intraoperative and postoperative relevant indicators of the two groups.Results The operation time and hospitalization time were longer in the chest group than those in the open group.The incision drainage volume on the first day after operation was higher in the chest group than that in the open group(P<0.05),but the cosmetic satisfaction of the chest group was better than that of the open group.Especially,the patients were very satisfied and satisfied in the five-level score of the chest group for 88.37%and the open group for 18.64%(P<0.05).The score was significantly higher in the chest group than in the open group.It was statistically significant differences in intraoperative blood loss,VAS score,Total central lymph node dissections,positive lymph node dissections,postoperative recurrent laryngeal nerve and parathyroid injury rate in the chest group compared to the open group(P>0.05).There was no recurrence or metastasis for patients in both groups followed up for an average of half a year after surgery.Conclusions It has outstanding aesthetic effect,safe and feasible clinical practice,and broad application prospect although PTMC has a large postoperative drainage volume,a long duration of operation and hospitalization.However,it should be performed on the basis of the strict indications and the operation of the skilled operator.

关 键 词：甲状腺肿瘤 胸乳径路 开放手术 

分 类 号：R739.91[医药卫生—肿瘤]