开放手术与完全腔镜手术治疗早期甲状腺乳头状癌的淋巴结清扫效果对比分析  

Comparative analysis of open thyroidectomy and totally endoscopic thyroidectomy:effects of lymph node dissection in treatment of papillary thyroid carcinoma

作　　者：张雅婷 陈梦圆 王一帆 马志强[1] ZHANG Ya-ting;CHEN Meng-yuan;WANG Yi-fan(Department of Breast and Thyroid Surgery,the First Affiliated Hospital of Henan University,Kaifeng 475000,China)

机构地区：[1]河南大学第一附属医院乳腺甲状腺外科,河南开封475000

出　　处：《腹腔镜外科杂志》2023年第3期181-185,190,共6页Journal of Laparoscopic Surgery

基　　金：2020年河南省医学科技攻关计划联合共建项目(LHGJ20200544)。

摘　　要：目的:分析开放手术与完全腔镜手术治疗早期甲状腺乳头状癌术后淋巴结转移情况,对比两种术式的淋巴结清扫效果。方法:回顾性选取2018年1月1日至2021年3月30日手术治疗的甲状腺乳头状癌患者,根据手术方式分为开放组与完全腔镜组,统计手术方式、性别、年龄、TNM分期,对比分析两组术中出血量、术中淋巴结清扫数量、术后淋巴结转移情况等。结果:共纳入223例患者,其中开放组110例,完全腔镜组113例。与开放组相比,完全腔镜组手术时间、引流管留置时间长,术后第2天、第3天引流量多,切口总长度短,切口满意度高,差异均有统计学意义(P<0.05)。两组术侧、术中淋巴结清扫数量、出血量、术后第1天引流量、住院时间、术后疼痛评分、并发症发生率、术后淋巴结转移率差异均无统计学意义(P>0.05)。结论:对于早期甲状腺乳头状癌患者,完全腔镜经胸入路甲状腺手术的淋巴结清扫效果、治疗效果与开放手术相近,但更具美容效果,适于对手术切口美容要求较高的患者。Objective:To compare the lymph node dissection effect between open thyroidectomy and totally endoscopic thyroidectomy for papillary thyroid carcinoma by the evaluation of postoperative lymph node metastasis.Methods:Patients with papillary thyroid carcinoma who underwent surgical treatment from Jan.1,2018 to Mar.30,2021 were retrospectively selected.Patients were divided into open group and endoscopic group according to operative type.Surgical method,gender,age and TNM stage were counted;intraoperative blood loss,intraoperative lymph node dissection,postoperative lymph node metastasis and other therapeutic indicators were comparatively analyzed to find the statistically significant difference between two different groups.Results:A total of 223 patients were included in this study.One hundred and ten cases received open surgery and 113 patients underwent endoscopic surgery.Compared with open group,in the endoscopic group operation time and tube drainage indwelling time were longer,the drainage volume was more on the 2nd and 3rd day after surgery,total incision length was shorter and the incision satisfaction was higher,the differences between the 2 groups were statistically significant(P<0.05).There was no significant difference in operation side,the number of dissected lymph nodes,intraoperative blood loss,drainage volume on the first day after operation,hospital stay,postoperative pain score,incidence of complications and postoperative lymph node metastasis rate between the two groups(P>0.05).Conclusions:The totally endoscopic thyroidectomy via breast approach is similar to open thyroid surgery in terms of lymph node dissection and therapeutic effect for patients with early thyroid papillary carcinoma.It has more cosmetic effects,may be suitable for patients with high cosmetic requirements for surgical incisions.

关 键 词：甲状腺肿瘤 甲状腺切除术 内窥镜检查 开放手术 颈淋巴结清扫术 淋巴转移 

分 类 号：R653[医药卫生—外科学]