经口腔前庭入路腔镜手术治疗cT1N0期甲状腺癌的效果及术后复发因素分析  

Endoscopic surgery via oral vestibular approach in the treatment of cT1N0 stage thyroid cancer:Efficacy and analysis of postoperative recurrence factors

作　　者：张佳琦 李琰 ZHANG Jiaqi;LI Yan(Department of Thyroid and Breast Surgery,Puren Hospital Affiliated to Wuhan University of Science and Technology/Medical College of Wuhan University of Science and Technology,Wuhan 430000,China)

机构地区：[1]武汉科技大学附属普仁医院/武汉科技大学医学部医学院甲状腺乳腺外科,湖北武汉430000

出　　处：《中国肿瘤外科杂志》2024年第2期126-131,共6页Chinese Journal of Surgical Oncology

基　　金：湖北省自然科学基金(2019CFC844)。

摘　　要：目的探讨经口腔前庭入路腔镜手术治疗cT1N0期甲状腺癌的疗效及术后复发的相关因素。方法2018年3月至2020年3月,选取在武汉科技大学附属普仁医院甲状腺乳腺外科进行手术的65例cT1N0期甲状腺癌患者为研究对象。通过随机数表法,将其分为对照组(n=32)和观察组(n=33)。对照组接受传统开放甲状腺癌手术治疗,观察组接受经口腔前庭入路腔镜手术治疗。比较两组患者的手术情况(手术时间、术中出血量、中央区淋巴结清扫数、术后引流量、颈部恢复活动时间),术后1 d、3 d、5 d的疼痛程度[视觉模拟评分表(VAS)],术前及术后24 h的炎症水平[白细胞计数(WBC)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]以及术后2个月、5个月随访患者的切口恢复情况[温哥华瘢痕评定量表(VSS)、观测者瘢痕评价量表(OSAS)]。同时分析导致术后复发的因素。结果两组患者的基线数据差异均无统计学意义(P>0.05)。在手术情况方面,观察组的术中出血量、术后引流量、颈部恢复活动时间均低于对照组(P<0.05);观察组患者在术后不同时间节点的VAS评分均低于对照组(P<0.05);在术后24 h的炎症水平方面,观察组的WBC、TNF-α、CRP水平均低于对照组(P<0.05);在切口恢复情况上,术后2个月、5个月观察组的VSS、OSAS评分均低于对照组(P<0.05)。Cox多因素回归分析显示,肿瘤直径在1.1~2.0 mm、多发病灶、手术切缘阳性以及术后无放化疗是甲状腺癌术后复发的危险因素。结论经口腔前庭入路腔镜手术治疗cT1N0期甲状腺癌能够有效降低术后复发率,减少并发症,提高患者的甲状腺功能恢复情况及生活质量。肿瘤直径在1.1~2.0 mm、多发病灶、手术切缘阳性以及术后无放化疗是甲状腺癌术后复发的危险因素。Objective This study aimed to explore the therapeutic effects and factors associated with postoperative recurrence in the treatment of cT1N0 stage thyroid cancer using endoscopic surgery via oral vestibular approach.Methods Sixty-five patients with cT1N0 stage thyroid cancer who underwent surgery in the Department of Thyroid and Breast Surgery atPuren Hospital Affiliated to Wuhan University of Science and Technology from March 2018 to March 2020 were selected as the subjects of the study.By using a random number table method,they were divided into a control group(n=32)and an observation group(n=33).The control group underwent traditional open thyroid cancer surgery,and the observation group underwent endoscopic surgery via oral vestibular approach.The surgical conditions(surgical duration,intraoperative blood loss,number of central lymph node dissections,postoperative drainage volume,time for the neck to regain movement),pain levels on day 1,3,and 5 after surgery(using the Visual Analogue Scale(VAS)),levels of inflammation before and 24 hours after surgery(White Blood Cell count(WBC),Tumor Necrosis Factor-alpha(TNF-α),C-Reactive Protein(CRP)),and the condition of the surgical incision at thesecond and fifth months after surgery(using the Vancouver Scar Scale(VSS)and the Observer Scar Assessment Scale(OSAS))were compared between the two groups.Factors that contributed to postoperative recurrence were also analyzed.Results There were no significant differences in the baseline data between the two groups(P>0.05).Regarding the surgical conditions,the observation group showed less intraoperative blood loss,less postoperative drainage volume,and shorter time for the neck to regain movement than the control group(P<0.05).The observation group also had lower VAS scores at different postoperative time points compared to the control group(P<0.05).For the level of inflammation 24 hours after the surgery,the observation group showed lower levels of WBC,TNF-α,and CRP(P<0.05).In terms of incision recovery,the observation gro

关 键 词：甲状腺癌 经口腔前庭入路腔镜手术 复发因素 效果 

分 类 号：R736.1[医药卫生—肿瘤]