改良Miccoli术与经乳晕入路腔镜甲状腺手术治疗早期分化型甲状腺癌的临床疗效以及并发症分析  

Comparison of clinical efficacy and surgical complications between modified Miccoli surgery and trans-areolar endoscopic thyroid surgery for early differentiated thyroid cancer

作　　者：袁牧[1] 管晓青 吴骥[1] YUAN Mu;GUAN Xiaoqing;WU Ji(Department of Thyroid and Breast Surgery,Suqian People’s Hospital,Nanjing Gulou Hospital Group,Suqian 223800,China)

机构地区：[1]南京鼓楼医院集团宿迁市人民医院甲乳外科,223800

出　　处：《临床外科杂志》2020年第10期947-950,共4页Journal of Clinical Surgery

摘　　要：目的比较改良Miccoli术与经乳晕入路腔镜甲状腺手术治疗早期分化型甲状腺癌的临床疗效以及手术并发症。方法早期分化型甲状腺癌病人100例,根据手术方式分为改良Miccoli组及经乳晕入路组,每组各50例。改良Miccoli组使用改良Miccoli术式行甲状腺癌次全切或全切术,而经乳晕入路组经乳晕入路进行甲状腺癌次全切或全切术。比较两组病人手术指标、疼痛程度、美观度(VSS、PSAS)、咽部不适感评分(RSI)及声音障碍程度评分(VSI)、并发症发生情况及复发转移情况。结果改良Miccoli组手术时间、术后拔管时间、颈部恢复活动时间、住院时间短于经乳晕入路组(P<0.05),术中出血量少于经乳晕入路组(P<0.05)。术后12小时及24小时,改良Miccoli组VAS评分低于经乳晕入路组(P<0.05)。改良Miccoli组术后1个月VSS、PSAS高于经乳晕入路组,术后3天VSI低于经乳晕入路组(P<0.05)。两组术后均无切口感染、永久性喉返神经损伤,组间皮下瘀斑、手足麻木、颈部不适、声音嘶哑、暂时性喉返神经损伤、甲状旁腺损伤、切口出血发生率差异无统计学意义(P>0.05)。两组随访期间均无复发转移或死亡病例。结论改良Miccoli术与经乳晕入路腔镜手术均是安全有效的早期分化型甲状腺癌治疗手段。改良Miccoli术术中损伤更小、术后恢复更快、术后疼痛感低,但于颈部留下切口,美观度不足。美观度要求低的病人可优先选择改良Miccoli术腔镜手术。Objective To compare the clinical efficacy and surgical complications of modified Miccoli surgery and trans-areolar endoscopic thyroid surgery in the treatment of early differentiated thyroid cancer.Methods The clinical data of 100 patients with early differentiated thyroid cancer were retrospectively analyzed,and patients were divided into the modified Miccoli group and the areola approach group according to the random number table method,50 cases each.The modified Miccoli group used the modified Miccoli technique for subtotal or total resection of thyroid cancer,while the areola approach group used the areola approach for subtotal or total resection of the thyroid cancer.The surgical indicators,pain,aesthetics,pharyngeal discomfort score(RSI),and sound impairment score(VSI),complications,and recurrence and metastasis were compared between the two groups.Results The modified Miccoli group had shorter operation time,post-extubation time,neck recovery time,and hospital stay time than the areola approach group(P<0.05),and the intraoperative blood loss was less than the areola approach group(P<0.05).At 12 and 24 hours after surgery,the VAS score of the modified Miccoli group was lower than that of the areola approach group(P<0.05).In the modified Miccoli group,VSS and PSAS were higher at 1 month after operation than those of the areola approach group(P<0.05),and the VSI at 3 days after operation was lower than that of the areola approach group(P<0.05).There was no incision infection or permanent recurrent laryngeal nerve injury after surgery in the two groups.There was no significant difference in the incidence of subcutaneous ecchymosis,numbness of hands and feet,neck discomfort,hoarseness,transient recurrent laryngeal nerve injury,parathyroid injury,and incision bleeding between two groups(P>0.05).No recurrence,metastasis or death occurred during follow-up in both groups.Conclusion Both the modified Miccoli surgery and the areola endoscopic surgery are safe and effective treatments for early differentiated thyroid

关 键 词：改良Miccoli术 经乳晕入路 腔镜甲状腺手术 早期分化型甲状腺癌 

分 类 号：R736.1[医药卫生—肿瘤]