经侧颈部小切口胸锁乳突肌肌间入路行甲状腺癌根治术的临床分析  

Clinical analysis of radical resection of thyroid carcinoma through lateral neck small incision sternocleidomastoid intermuscular approach

作　　者：王佳惠 王朝晖[2] 陈义波[2] 孙一心 Wang Jiahui;Wang Zhaohui;Chen Yibo;Sun Yixin(School of Medicine,Unirersily of Electronie Science and Technology of China,Chengdu 610054,China;Department of Thyroid-Otolaryngology and Head and Neck Surgery,Affiliasted Cancer Hoaspital of University of Electronic Science and Technology of China,Sichuan Canncer Clinical Medical Research Center,Sichuan Cancer Haspital,Sichuan Cancer Reseurch Instiute,Chengdu 610041,China)

机构地区：[1]电子科技大学医学院,成都610054 [2]四川省肿瘤临床医学研究中心、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甲状腺耳鼻咽喉头颈外科,成都610041

出　　处：《中华内分泌外科杂志(中英文)》2025年第1期40-44,共5页Chinese Journal of Endocrine Surgery

基　　金：四川省干部保健科研课题(编号川干研2020-801)。

摘　　要：目的:探讨经侧颈部小切口胸锁乳突肌肌间入路(SMIA)行甲状腺癌根治手术的可行性及安全性。方法:收集2022年2月至2024年3月四川省肿瘤医院甲状腺耳鼻咽喉头颈外科收治的甲状腺乳头状癌(PTC)初治患者的临床资料,根据手术方式分为SMIA组及颈前正中低领横行切口入路(LACA)组。SMIA组为经侧颈部小切口胸锁乳突肌肌间入路行手术治疗52例,LACA组为经颈前正中低领切口颈白线入路行手术治疗100例。收集两组临床资料、围术期相关指标、术后美观效果及术后并发症等,计量资料组间比较采用独立样本t检验或Mann-Whitney U检验;计数资料组间比较采用χ^(2)检验。结果:两组在人口学统计特征、肿瘤临床特征比较差异无统计学意义。与LACA组相比,SMIA组手术时间较长[(83.85±18.72)min比(71.33±15.50)min(t=4.39,P<0.001)],术后总引流量明显减少[(61.29±41.80)mL比(99.0±35.80)mL(Z=-4.65,P<0.001)],拔管时间明显缩短[(2.81±0.82)d比(3.19±0.66)d(Z=-3.31,P<0.001)],差异有统计学意义。术后声嘶并发症两组差异无统计学意义(χ^(2)=0.01,P=0.932)。两组均未出现术后出血、切口感染情况。术后1个月随访患者自我症状,SMIA组出现吞咽不适症状人数明显少于LACA组(χ^(2)=4.30,P=0.038);两组在颈部僵硬(χ^(2)=3.16,P=0.075)、瘢痕增生(χ^(2)=0.04,P=0.840)、切口美观效果评分(Z=-0.73,P=0.468)方面比较,差异无统计学意义。结论:SMIA行甲状腺癌根治术式安全可行、美观,值得在临床中推广,尤其适用于肿瘤T分期较早的单侧癌灶患者。Objective:To investigate the feasibility and safety of radical thyroidectomy through a small incision in the side neck of the sternocleidomastoid intermuscular approach.Methods:Clinical data of newly treated patients with papillary thyroid carcinoma admitted to the Department of Thyroid-Otolaryngology and Head and Neck Surgery,Sichuan Cancer Hospital from Feb.2022 to Mar.2024 were collected.They were divided into SMIA group and LACA group according to surgical methods.In the SMIA group,52 cases were treated by the sternocleidomastoid intermuscular approach with a small incision on the side of the neck.In the LACA group,100 cases were treated by the cervical white line approach with a low cut incision on the front of the neck.Clinical data of the two groups,such as perioperative related indicators,postoperative aesthetic effects and postoperative complications were collected.Independent sample t test or Mann-Whitney U test were compared between the measurement data groups.Chi-square test was used for comparison between data sets.Results:There was no significant difference in demographic and clinical characteristics of tumor between the two groups.Compared with the control group,the operation time of the observation group was longer(83.85±18.72minvs71.33±15.50min,t=4.39,P<0.001),the total postoperative drainage volume was significantly reduced(61.29±41.80ml vs.99±35.80ml,Z=-4.65,P<0.001),and the extubation time was significantly shortened(2.81±0.82d vs.3.19±0.66d,Z=-3.31,P<0.001),and the difference was statistically significant.There was no difference in postoperative transient hoarseness between the two groups(χ^(2)=0.01,P=0.932).Patient’s self-feeling was followed up one month after surgery.The number of patients with swallowing discomfort in the SMIA group was significantly lower than that in the LACA group(χ^(2)=4.30,P=0.017).There was no significant difference between the two groups in neck stiffness(χ^(2)=3.16,P=0.075),scar hyperplasia(χ^(2)=0.04,P=0.840),and incision aesthetic effect score(Z=-0.7

关 键 词：甲状腺癌 侧颈部小切口 胸锁乳突肌肌间入路 

分 类 号：R736.1[医药卫生—肿瘤]