不同入路腔镜甲状腺手术治疗甲状腺癌的临床效果分析  

Clinical effect analysis of endoscopic thyroid surgery for thyroid cancer through different approaches

作　　者：吴雪松 秦彦超 韩飞[1] 丁炜 秦东广 Wu Xuesong;Qin Yanchao;Han Fei;Ding Wei;Qin Dongguang(Department of Head and Neck Surgery,Shanxi Cancer Hospital,Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030000,China)

机构地区：[1]山西省肿瘤医院、中国医学科学院肿瘤医院山西医院、山西医科大学附属肿瘤医院头颈外科,太原030000

出　　处：《中华内分泌外科杂志（中英文）》2024年第4期473-478,共6页Chinese Journal of Endocrine Surgery

基　　金：山西省科技厅项目(202203021222388)。

摘　　要：目的比较不同入路腔镜甲状腺手术对甲状腺癌患者临床效果的影响。方法前瞻性纳入2020年1月至2023年1月山西省肿瘤医院头颈外科由同一经验丰富的手术团队实施完全腔镜甲状腺切除术(complete endoscopic thyroidectomy,CET)治疗甲状腺癌患者96例,随机数字表法分为经锁骨下组(经锁骨下入路CET)48例和经口组(经口腔前庭入路CET)48例。比较两组手术及术后康复情况、并发症、美容满意度评分,术前、术后1、3及7 d检测免疫指标[T淋巴细胞亚群(CD3+、CD4+)、CD4+/CD8+]、血清可溶性白细胞介素2受体(soluble interleukin 2 receptor,SIL-2R)、组织激肽释放酶11(kallikrein11,KLK11)、中期因子(midkine,MK)水平,术后1、3及7 d采用视觉模拟量表(visual analog scale,VAS)、颈部损伤指数、吞咽障碍指数评估颈部功能。结果经口组与经锁骨下组手术时间分别为(117.58±10.87)min和(101.84±11.35)min(P<0.001),住院时间分别为(4.31±0.86)d和(5.12±0.91)d(P<0.001),引流量分别为(65.13±12.49)mL和(78.65±15.32)mL(P<0.001)。术后1、3及7 d,经口组和经锁骨下组CD3+分别为(41.53±3.86)%和(38.29±3.51)%(P<0.001),(46.21±4.35)%和(42.81±4.06)%(P=0.001),(48.23±4.47)%和(45.10±4.23)%(P<0.001);CD4+水平分别为(33.27±3.90)%和(30.18±3.45)%(P<0.001),(36.28±4.15)%和(33.46±3.87)%(P=0.001),(38.69±4.22)%和(35.17±4.10)%(P<0.001);CD4+/CD8+水平分别为(1.31±0.22)和(1.16±0.21)(P=0.001),(1.40±0.23)和(1.20±0.22)(P<0.001),(1.58±0.24)和(1.45±0.25)(P=0.011)。术后1、3及7 d,经口组与经锁骨下组血清SIL-2R、KLK11、MK水平、VAS评分、颈部损伤指数、吞咽障碍指数相比,差异无统计学意义(P>0.05)。经口组和经锁骨下组并发症发生率分别为8.33%(4/48)和22.92%(11/48)(P=0.049),美容满意度分别为95.83%(46/48)和81.25%(39/48)(P=0.025)。结论经口腔前庭入路与经锁骨下入路行CET治疗甲状腺癌均对颈部功能造成损伤,前者能减轻免疫功能损伤,有助于术后早ObjectiveTo compare the clinical effects of endoscopic thyroidectomy with different approaches on patients with thyroid cancer.MethodsA prospective study was conducted on 96 patients with thyroid cancer who underwent complete endoscopic thyroidectomy(CET)by the same experienced surgical team in the Head and Neck Surgery Department of Shanxi Cancer Hospital from Jan.2020 to Jan.2023.The patients were randomly divided into a trans-subclavian approach group of 48 cases and a transoral vestibular access group of 48 cases using a random number table method.The trans-subclavian approach group underwent CET via the subclavian approach,while the transoral vestibular access group underwent CET via the oral vestibular approach.The surgical and postoperative rehabilitation conditions,complications,and cosmetic satisfaction scores were compared between the two groups.The immune indicators(T lymphocyte subsets(CD3+,CD4+),CD4+/CD8+),serum soluble interleukin 2 receptor(SIL-2R),tissue kallikrein 11(KLK11),midkine(MK)levels were measured before surgery.At 1 d,3 d,and 7 d postoperatively,neck function was assessed using the visual analog scale(VAS),neck injury index,and dysphagia index.ResultsThe operation time of the transoral vestibular access group and the Trans-subclavian approach group were(117.58±10.87)min and(101.84±11.35)min,respectively(P<0.001),and the hospitalization time was(4.31±0.86)d and(5.12±0.91)d,respectively(P<0.001).The drainage volume was(65.13±12.49)mL and(78.65±15.32)mL,respectively(P<0.001).At 1,3,and 7 days after surgery,the CD3+levels in the transoral vestibular access group and the trans-subclavian approach group were(41.53±3.86)%and(38.29±3.51)%,respectively(P<0.001),(46.21±4.35)%and(42.81±4.06)%,respectively(P=0.001),and(48.23±4.47)%and(45.10±4.23)%,respectively(P<0.001).The CD4+levels were(33.27±3.90)%and(30.18±3.45)%,respectively(P<0.001),(36.28±4.15)%and(33.46±3.87)%,respectively(P=0.001),and(38.69±4.22)%and(35.17±4.10)%,respectively(P<0.001).The CD4+/CD8+levels were(1.31±0.22)an

关 键 词：甲状腺癌 完全腔镜甲状腺切除术 锁骨下入路 口腔前庭入路 免疫功能 颈部功能 美容满意度 

分 类 号：R736.1[医药卫生—肿瘤]