全乳晕入路腔镜与开放甲状腺切除术治疗甲状腺乳头状癌的回顾性队列研究  

A retrospective cohort study of total areolar endoscopic approach versus open thyroidectomy for the treatment of papillary thyroid carcinoma

作　　者：蒋洪朋 丁国乾 赵宁[1] 滕长胜[1] Jiang Hongpeng;Ding Guoqian;Zhao Ning;Teng Changsheng(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院普外科,北京100050

出　　处：《国际外科学杂志》2023年第5期338-344,共7页International Journal of Surgery

基　　金：首都医科大学本科生科研创新项目(XSKY2021208)。

摘　　要：目的比较全乳晕入路腔镜(AET)与开放甲状腺切除术(OT)治疗甲状腺乳头状癌的效果。方法根据入排标准最终纳入2017年1月—2020年1月就诊于首都医科大学附属北京友谊医院普外科的428例甲状腺乳头状癌女性患者,其中183例行AET手术(AET组),245例行OT手术(OT组)。通过直接和倾向评分匹配法分析,比较2种术式在手术时间、术中甲状旁腺移植率、术中神经损伤、术后并发症、淋巴结清扫数、二次手术率、术后2年淋巴结转移及入路肿瘤种植等方面的差异。采用SPSS 25.0软件进行统计学分析。正态分布的计量资料以均数±标准差(±s)表示,组间比较采用t检验;计数资料以例(%)表示,组间比较采用χ^(2)检验。结果AET组年龄(38.89±9.08)岁、体重(62.10±10.45)kg、身高(161.97±5.31)cm;OT组年龄(45.88±12.47)岁、体重(65.11±12.72)kg、身高(161.62±5.24)cm。两组患者在年龄、体重、体重指数等方面差异有统计学意义(P<0.05)。AET组的手术时间明显长于OT组,分别为(183.00±137.22)min、(87.94±28.25)min(t=16.67,P<0.001),而OT组的甲状旁腺移植率为49.39%(121/245)明显高于AET组的34.97(64/183)(χ^(2)=8.87,P=0.003)。两组在术中神经损伤、术后并发症、二次手术率、淋巴结清扫数、术后2年淋巴结转移及入路肿瘤种植等方面差异均无统计学意义。基于年龄、体重、体重指数等差异基线数据进行1∶1倾向评分匹配病例,分别得到183例行AET手术患者(AET-PS组)和OT手术患者(OT-PS组),统计分析结果同倾向评分匹配前的分析。AET-PS组手术时间为(137.22±32.77)min明显长于OT-PS组的(90.26±29.35)min(t=14.44,P<0.001);OT-PS组甲状旁腺移植率为53.01%(97/183)明显高于AET-PS组的34.97%(64/183)(χ^(2)=12.08,P=0.001);两组在术中神经损伤、术后并发症、二次手术率、淋巴结清扫数、术后2年淋巴结转移及入路肿瘤种植等方面的均无统计学差异。结论AET和OT在安全性和肿瘤Objective To compare the effectiveness of areola approach endoscopic thyroidectomy(AET)and conventional open thyroidectomy(OT)in treating papillary thyroid carcinoma.Methods Four hundred and twenty-eight female patients with papillary thyroid carcinoma who were treated at the Department of General Surgery,Beijing Friendship Hospital between January 2017 and January 2020 were included according to the inclusion and exclusion criteria,of whom 183 underwent AET(AET group)and 245 underwent OT(OT group).Direct comparison and subsequent propensity score matching methodology were utilized to compare the differences between the two operation methods in terms of surgical time,intraoperative parathyroid transplantation rate,intraoperative nerve injury,postoperative complications,reoperation rate,number of lymph node dissections,postoperative lymph node metastasis at 2 years,and route tumor implantation.Data analysis was performed by using SPSS 25.0 software.The metric data of normal distribution was represented by mean±standard deviation(±s),and the t-test was used for between-group comparison.The Chi-test was used for between-group comparison of count data.Results The AET group had an age of(38.89±9.08)years,weight of(62.10±10.45)kg,and height of(161.97±5.31)cm;the OT group had an age of(45.88±12.47)years,weight of(65.11±12.72)kg,and height of(161.62±5.24)cm.The differences in age,weight,and body mass index between the two groups were statistically significant(P<0.05).The surgical time in the AET group was(183.00±137.22)min,which was significantly longer than(87.94±28.25)min of the OT group(t=16.67,P<0.001).The parathyroid transplantation rate in the OT group was significantly higher than that in the AET group(49.39%vs 34.97%,χ^(2)=8.87,P=0.003).There were no statistically significant differences between the two groups in terms of intraoperative nerve injury,postoperative complications,reoperation rate,number of lymph node dissections,postoperative lymph node metastasis at 2 years,and route tumor implantation.A

关 键 词：甲状腺肿瘤 甲状腺切除术 回顾性研究 全乳晕入路 腔镜 

分 类 号：R736.1[医药卫生—肿瘤]