无充气经腋窝后入路腔镜甲状腺癌手术效果评价  

Effect evaluation of gasless endoscopic thyroidectomy via axillary posterior approach for unilateral papillary thyroid microcarcinoma

作　　者：刘岩 田志龙[1] 高新宝[1] 袁福康[1] 耿厚法 贾高磊[1] LIU Yan;TIAN Zhilong;GAO Xinbao;YUAN Fukang;GENG Houfa;JIA Gaolei(Department of Vascular Thyroid Hernia Surgery,Xuzhou Central Hospital,Xuzhou,Jiangsu 221006,P.R.China)

机构地区：[1]徐州市中心医院血甲疝微创外科,江苏徐州221006

出　　处：《中国普外基础与临床杂志》2022年第11期1463-1467,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：江苏省青年医学人才重点项目(项目编号:QNRC2016388)。

摘　　要：目的 探讨无充气经腋窝后入路腔镜甲状腺癌手术的治疗效果。方法 回顾性收集2020年1月至2022年2月期间徐州市中心医院血甲疝微创外科收治并由同一手术组医师采用无充气经腋窝后入路(设为观察组)和经胸乳入路(设为对照组)腔镜甲状腺手术治疗的单侧甲状腺微小乳突状癌患者的临床病理资料,比较2组患者的手术时间、术中意外出血量、喉返神经显露时间、淋巴结清扫数目、总住院时间及术后并发症如喉上神经损伤、饮水呛咳、暂时性声音嘶哑、一过性低钙血症、隧道血肿和颈部不适感,同时评价2组患者的美容效果。结果 本研究共纳入符合研究条件的患者87例,其中观察组47例,对照组40例,2组患者的基线资料如性别、年龄、肿瘤最大直径、肿瘤位置等比较差异均无统计学意义(P>0.05)。与对照组比较,观察组喉返神经显露时间更短(P<0.001)、淋巴结清扫数目更多(P=0.034),但术中意外出血后出血量更多(P=0.015),2组患者手术时间及总住院时间比较差异无统计学意义(P>0.05)。术后2组均未出现喉上神经损伤及饮水呛咳,并且2组患者在术后暂时性声音嘶哑、一过性低钙血症及隧道血肿方面比较差异均无统计学意义(P>0.05),但观察组术后颈部不适感发生率低于对照组(P=0.043)且其术后美容效果满意程度评分高于对照组(P<0.001)。结论 从本研究结果看,单侧甲状腺微小乳突状癌采用无充气经腋窝后入路腔镜手术安全、有效,能较快地显露出喉返神经并有利于淋巴结清扫,而且其美容效果较好。Objective To explore the therapeutic effect of gasless endoscopic thyroidectomy via axillary posterior approach for unilateral papillary thyroid microcarcinoma. Methods The clinicopathologic data of patients with unilateral papillary thyroid microcarcinoma who were treated by gasless endoscopic thyroidectomy via axillary posterior approach(observation group) or breast approach(control group) in the Xuzhou Central Hospital from January 2020 to February 2022 were collected. The operation time, accidental intraoperative bleeding, exposure time of recurrent laryngeal nerve, number of lymph node dissection, total hospital stay, and postoperative complications such as superior laryngeal nerve injury, cough due to drinking, temporary hoarseness, transient hypocalcemia, tunnel hematoma, and neck discomfort were compared between the two groups. Meanwhile, the cosmetic effects of the two groups were evaluated.Results A total of 87 patients who met the study conditions were enrolled in this study, including 47 cases in the observation group and 40 cases in the control group. There were no statistical differences in the baseline data such as gende, age, maximum tumor diameter, location of tumor, etc. between the two groups(P>0.05). Compared with the control group, the exposure time of recurrent laryngeal nerve was shorter(P<0.001) and the number of lymph node dissection was more(P=0.034), but the accidental intraoperative bleeding during operation was more(P=0.015) in the observation group. There were no statistical differences in the operation time and total hospital stay between the two groups(P>0.05). There were no superior laryngeal nerve injury and cough due to drinking in the two groups after operation, and there were no statistical differences between the two groups in the terms of postoperative temporary hoarseness, transient hypocalcemia, and tunnel hematoma(P>0.05), but it was found that the incidence of postoperative neck discomfort in the observation group was lower than that in the control group(P=0.043), and th

关 键 词：腔镜 腋窝后入路 甲状腺微小乳突状癌 美容满意程度 

分 类 号：R736.1[医药卫生—肿瘤]