经腋无充气腔镜与传统颈部开放手术治疗PTC的疗效分析  

Chen Xiaolei,Li Chao,Zhou Yuqiu,Cai Yongcong,Ning Yudong,Shui Chunyan,Wang Xu,Zeng Zixun,Qin Gang,Ge Minghua,Zheng Chuanming

作　　者：陈孝磊 李超 周雨秋[2] 蔡永聪 宁玉东[2] 税春燕 汪旭 曾梓洵 覃纲 葛明华 郑传铭 Chen Xiaolei;Li Cha;Zhou Yuqiu;Cai Yongcong;Ning Yudong;Shui Chunyan;Wang Xu;Zeng Zixun;Qin Gang;Ge Minghua;Zheng Chuanming(Department of Otorhinolaryngology Head and Neck Surgery,Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan Province,China;Department of Head and Neck Surgery,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,Affiliated Cancer Hospital of University of Electronic Science and Technology of China,Chengdu 610041,China;Department of Head and Neck Surgery,Zhejiang Provincial People′s Hospital,People′s Hospital of Hangzhou Medical College,Hangzhou 310014,China)

机构地区：[1]西南医科大学附属医院耳鼻咽喉头颈外科,泸州646000 [2]四川省肿瘤临床医学中心、四川省肿瘤医院研究所、四川省癌症防治中心电子科技大学附属肿瘤医院头颈外科,成都610041 [3]浙江省人民医院、杭州医学院附属人民医院头颈外科,杭州310014

出　　处：《中华耳鼻咽喉头颈外科杂志》2023年第4期351-357,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：四川省科技创新创业苗子工程(22MZGC0168)。

摘　　要：目的比较经腋无充气腔镜与开放术式在甲状腺乳头状癌(PTC)的疗效及术后生活质量的差异。方法回顾性分析四川省肿瘤医院头颈外科2019年5月至2021年12月采用经腋无充气腔镜手术(142例)与传统颈部开放手术(201例)治疗单侧PTC的343例患者的病例资料,其中男性97例,女性246例,年龄20~69岁。对入组患者进行1∶1倾向评分匹配(PSM),对匹配成功后的2组患者的基本特征、围手术期临床结果、术后并发症、术后生活质量(采用甲状腺癌特异性生活质量量表)、美观满意度等方面进行比较。应用SPSS 26.0软件进行统计学分析。结果PSM后共纳入190例患者,腔镜组和开放组各95例,在术中失血量[20(20)ml比20(10)ml,M(IQR),下同,Z=-2.22]、术后引流量[170(70)ml比101(55)ml,Z=-7.91]、手术时间[135(35)min比95(35)min,Z=-7.34]、住院费用[(28188.7±2765.1)元比(25643.5±2610.7)元,x¯±s,下同,t=0.73]、术后住院时间[(3.1±0.9)d比(2.6±0.9)d,t=-3.24]、引流管放置时间[(2.5±0.8)d比(2.0±1.0)d,t=-4.16],腔镜组患者高于开放组,差异均有统计学意义(P值均<0.05);在手术并发症方面差异无统计学意义(P>0.05)。2组患者的术后生活质量在神经肌肉、心理、瘢痕、感觉冷方面差异有统计学意义(P值均<0.05),其他生活质量评分差异均无统计学意义(P值均>0.05)。在术后6个月美观满意度上腔镜组优于开放组,差异有统计学意义(χ^(2)=41.47,P<0.05)。结论无充气经腋窝腔镜手术是一种安全可靠的手术方式,与传统经颈部入路的甲状腺癌根治术相比,其美容效果显著,并且可在一定程度上提高患者术后的生活质量。Objective To compare the efficacies between open surgery and axillary non-inflatable endoscopic surgery in papillary thyroid carcinoma(PTC).Methods A retrospective analysis was performed on 343 patients with unilateral PTC treated by traditional open surgery(201 cases)and transaxillary non-inflating endoscopic surgery(142 cases)from May 2019 to December 2021 in the Head and Neck Surgery of Sichuan Cancer Hospital.Among them,97 were males and 246 were females,aged 20-69 years.1∶1 propensity score matching(PSM)was performed on the enrolled patients,and the basic characteristics,perioperative clinical outcomes,postoperative complications,postoperative quality of life(Thyroid Cancer-Specific Quality of Life),aesthetic satisfaction and other aspects of the two groups were compared after successful matching.SPSS 26.0 software was used for statistical analysis.Results A total of 190 patients were enrolled after PSM,with 95 cases in open group and 95 cases in endoscopic group.Intraoperative blood losses for endoscopic and open groups were[20(20)ml vs.20(10)ml,M(IQR),Z=-2.22],postoperative drainage volumes[170(70)ml vs.101(55)ml,Z=-7.91],operative time[135(35)min vs.95(35)min,Z=-7.34],hospitalization cost[(28188.7±2765.1)yuan vs.(25643.5±2610.7)yuan,x¯±s,t=0.73],postoperative hospitalization time[(3.1±0.9)days vs.(2.6±0.9)days,t=-3.24],and drainage tube placement time[(2.5±0.8)days vs.(2.0±1.0)days,t=-4.16],with statistically significant differrences(all P<0.05).There was no significant difference in surgical complications(P>0.05).There were significant diffferences between two groups in the postoperative quality of life scores in neuromuscular,psychological,scar and cold sensation(all P<0.05),while there were no statistically significant differences in other quality of life scores(all P>0.05).In terms of aesthetic satisfaction 6 months after surgery,the endoscopic group was better than the open group,with statistically significant difference(χ^(2)=41.47,P<0.05).Conclusion Endoscopic thyroidectomy by a gasless

关 键 词：甲状腺切除术 外科手术 微创性 无充气 腋窝入路 生活质量 

分 类 号：R736.1[医药卫生—肿瘤]