腔镜下不同手术入路甲状腺切除术对cN0期甲状腺乳头状癌的手术效果观察  

Surgical effect of endoscopic thyroidectomy via different surgical approaches on cN0 papillary thyroid carcinoma

作　　者：徐虹 赵帅[1] 方敏 王龙妹 龚宇蓉 XU Hong;ZHAO Shuai;FANG Min;WANG Longmei;GONG Yurong(Department of General Surgery,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院普外科,上海200092

出　　处：《西部医学》2025年第3期356-360,共5页Medical Journal of West China

基　　金：国家自然科学基金资助项目(82103520)。

摘　　要：目的探讨腔镜下不同手术入路甲状腺切除术对cN0期甲状腺乳头状癌(PTC)的手术效果。方法回顾性分析2019年8月—2022年11月于本院就诊并接受腔镜手术治疗的118例cN0期PTC患者的临床资料,根据腔镜下不同手术入路,分为胸乳组与经口组,应用倾向性评分匹配法各纳入59例患者。比较两组围术期相关指标。结果经口组术后引流量、住院时长均少于胸乳组(P<0.05),而手术时间、中央区淋巴结清扫数目多于胸乳组(P<0.05);经口组术后12、24 h VAS评分均低于胸乳组(P<0.05);术后3 d,经口组吞咽功能优于胸乳组(P<0.05);术后3个月,经口组瘢痕评估量表评分低于胸乳组(P<0.05);随访1年,组间术后复发、无进展生存期比较无明显差异(P>0.05)。结论经胸乳入路腔镜术与经口腔前庭腔镜术治疗cN0期PTC整体疗效相当,但经口腔前庭入路腔镜术后恢复更快,更值得应用。Objective To observe the surgical effect of endoscopic thyroidectomy via different surgical approaches on stage cN0 papillary thyroid carcinoma(PTC).Methods The clinical data of patients with stage cN0 PTC who underwent endoscopic surgery in our hospital from August 2019 to November 2022 were retrospectively analyzed.According to different endoscopic surgical approaches,they were divided into thoracic breast group and transoral group.The propensity score matching method was used to selected 59 patients in each group.The perioperative indicators compared between the two groups.Results The postoperative drainage volume and hospital stay in transoral group were less or shorter than those in thoracic breast group(P<0.05),and the surgical time and the number of dissected central lymph nodes were longer or more than those in thoracic breast group(P<0.05).The VAS scores in transoral group after surgery were lower than those in thoracic breast group(P<0.05).At 3 days after surgery,the swallowing function in transoral group was higher than that in thoracic breast group(P<0.05).The scores of Patient and Observer Scar Assessment Scale in transoral group at 3 months after surgery were lower than those in thoracic breast group(P<0.05).After 1 year of follow-up,there was no difference in the total incidence rate of postoperative local recurrence and progression-free survival between the two groups(P>0.05).Conclusion The short-term and long-term curative effects of endoscopic surgery via transthoracic breast approach and endoscopic surgery via transoral vestibular approach in the treatment of stage cN0 papillary thyroid carcinoma are comparable,but endoscopic surgery via transoral vestibular approach has faster postoperative recovery and better aesthetics.

关 键 词：甲状腺乳头状癌 腔镜手术 经口腔前庭入路 经胸乳入路 中央淋巴结清扫 吞咽功能 

分 类 号：R736.1[医药卫生—肿瘤]