全腔镜下颈侧区淋巴清扫与传统开放手术治疗甲状腺乳头状癌N1b患者的对比研究  

Comparative study of endoscopic lateral neck dissection versus conventional open surgery for papillary thyroid carcinoma(N1b)

作　　者：庞凤舜[1] 林淑梅 陈经宝[1] 张晓波[1] 林展宏[1] 蔡北源[1] 李明显[1] 陈振欣 秦有[1] PANG Fengshun;LIN Shumei;CHEN Jingbao;ZHANG Xiaobo;LIN Zhanhong;CAI Beiyuan;LI Mingxian;CHEN Zhenxin;QIN You(Department of Surgery,Fangcun Branch,Guangdong Provincial Hospital of Traditional Chinese Medicine Guangzhou,Guangdong,510000,China)

机构地区：[1]广东省中医院芳村分院外五科,广东广州510000

出　　处：《中国耳鼻咽喉头颈外科》2021年第4期218-221,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：广东省科技厅项目(2013B032500010)。

摘　　要：目的对比分析甲状腺乳头状癌N1b患者行全腔镜下颈侧区淋巴清扫(腔镜组)和传统开放术式(开放组)的安全性、有效性。方法 2017年1月~2019年12月在广东省中医院芳村分院外五科接受单侧颈侧区淋巴结清扫的48例甲状腺乳头状癌N1b患者临床资料,对比分析腔镜组和开放组的相关数据。结果 21例患者完成腔镜手术,27例完成开放手术。两组均顺利完成手术,未出现气管、颈静脉等比邻结构损伤,均未出现永久性甲状旁腺功能低下、喉返神经损伤等并发症。腔镜组手术时间(349.14±78.17)min,开放组手术时间为(203.85±60.43)min,两组对比有统计学意义(t=7.267,P<0.05);切口满意程度VAS评分方面,腔镜组为8.24±0.60,开放组为4.81±0.95,差异有统计学意义(t=14.359,P<0.05);II区淋巴结清扫数目方面,腔镜组为(8.43±4.30)个,开放组为(4.37±3.68)个,差异有统计学意义(t=3.517,P<0.05)。两组病例在基本资料和临床病理特征、并发症、术后住院时间等方面均无统计学差异。结论全腔镜下侧颈区林巴结清扫是安全有效的,对比传统开放手术未增加手术并发症且有更好的美容效果。OBJECTIVE To compare the safety and effectiveness of total endoscopic lateral neck dissection(ELND) and conventional open surgery(OPEN) for papillary thyroid carcinoma(PTC with N1b).METHODS A total of 48 patients diagnosed with PTC(N1b) who underwent either total endoscopic unilateral neck dissection or conventional open surgery from January 2017 to December 2019 were included.The analysis was compared between primary outcomes and demographic characteristics.RESULTS A total of 48 patients were admitted with PTC(N1b),out of which 21 patients were completed with the ELND surgery,out of 27 patients who have performed the OPEN surgery.There was no injury of adjacent structures such as trachea and jugular vein,permanent hypoparathyroidism,and recurrent laryngeal nerve injury in both groups.The operation time of the ELND group and the OPEN group were (349.14±78.17)minutes and (203.85±60.43)minutes,respectively.The difference between the two groups was statistically significant(t=7.267,P<0.05);The VAS scores of incision satisfaction in the ELND group and the OPEN group were 8.24±0.60 and 4.81±0.95,respectively,with statistical significance(t=14.359,P<0.05);Moreover,the number of lymph node dissection in area II between the two groups were 8.43±4.30 and 4.37±3.68,respectively,with statistical significance(t=3.517,P<0.05).There was no significant difference in basic data,clinicopathological features,complications,and postoperative hospital stay between the two groups.CONCLUSIONThe results shows that total endoscopic lateral neck dissection achieved comparable safety and effectiveness as conventional open surgery for PTC(N1b) and had better cosmetic results.

关 键 词：甲状腺肿瘤 癌 乳头状 外科手术 颈淋巴结清扫术 对比研究 

分 类 号：R736.1[医药卫生—肿瘤]