无充气腋窝入路腔镜手术和传统颈部开放手术治疗甲状腺乳头状癌的安全性和有效性比较  

Comparative study on safety and effectiveness of gasless endoscopic thyroidectomy via transaxillary approach and conventional open thyroidectomy in patients with papillary thyroid cancer

作　　者：周奥妮 吕浙宽 郭雅文 丁玲玲 滕伟东 李琳琳 骆婕妤 郑传铭 ZHOU Aoni;LU Zhekuan;GUO Yawen;DING Lingling;TENG Weidong;LI Linlin;LUO Jieyu;ZHENG Chuanming(Otolaryngology&Head and Neck Center,Cancer Center,Department of Head and Neck Surgery,Zhejiang Provincial People’s Hospital(Affiliated People’s Hospital),Hangzhou Medical College,Hangzhou 310014,P.R.China;The Second School of Clinical Medicine,Hangzhou Normal University,Hangzhou 310018,P.R.China;Graduate Training Base of Wenzhou Medical University(Zhejiang Provincial People’s Hospital),Wenzhou,Zhejiang 325000,P.R.China;Zhejiang Provincial Clinical Research Center for Head&Neck Cancer,Hangzhou 310014,P.R.China;Zhejiang Key Laboratory of Precision Medicine Research on Head&Neck Cancer,Hangzhou 310014,P.R.China)

机构地区：[1]浙江省人民医院(杭州医学院附属人民医院)耳鼻咽喉-头颈外科中心头颈外科,杭州310014 [2]杭州师范大学第二临床医学院,杭州310018 [3]温州医科大学研究生培养基地(浙江省人民医院),浙江温州325000 [4]浙江省头颈部恶性肿瘤临床医学研究中心,杭州310014 [5]浙江省头颈肿瘤精准医学研究重点实验室,杭州310014

出　　处：《中国普外基础与临床杂志》2025年第3期332-339,共8页Chinese Journal of Bases and Clinics In General Surgery

基　　金：浙江省“尖兵”“领雁”研发攻关计划项目(项目编号:2024C03166)。

摘　　要：目的评估无充气腋窝入路腔镜手术治疗甲状腺乳头状癌(papillary thyroid cancer,PTC)的安全性及有效性。方法回顾性收集浙江省人民医院2018年1月至2023年6月期间行无充气腋窝入路腔镜手术(简称“腔镜组”)和颈部开放手术(简称“开放组”)治疗的PTC患者,对纳入患者采用倾向性评分匹配后比较2组患者的术中及术后结果。应用SPSS 26.0软件进行统计学分析,检验水准α=0.05。结果纳入患者经倾向性评分匹配后,腔镜组409例、开放组421例,除了肿瘤位置、脉管侵犯及腺内播散以及术前三碘甲状腺原氨酸总量、甲状腺素总量水平(P<0.05)外,2组基线资料比较差异无统计学意义(P>0.05)。与开放组比较,腔镜组的术中失血量更少(P<0.05)、切口满意度及美容效果评分更高(P<0.05),但淋巴结清扫数目更少(P<0.05)、手术时间更长(P<0.05),腔镜组和开放组术后总并发症发生率比较差异无统计学意义(3.6%比5.8%,P=0.127),随访1年内腔镜组和开放组患者复发率比较差异亦无统计学意义(0.2%比0.5%,P=0.099)。结论从本研究结果看,无充气腋窝入路腔镜甲状腺癌根治术展现了作为PTC治疗手段的安全性与可靠性,它能达到与传统颈部开放手术同样的安全性和有效性。但是从本研究中也看到,年轻的女性患者只要有病情许可(比如肿瘤早期、低侵袭性)的情况下,选择腔镜手术治疗的意愿更强烈。Objective To evaluate the safety and efficacy of gasless endoscopic thyroidectomy via transaxillary approach in treating papillary thyroid cancer(PTC).Methods The patients who underwent gasless endoscopic thyroidectomy(Abbreviated as the“endoscopic group”)and neck open surgery(Abbreviated as the“open group”),in the Zhejiang Provincial People’s Hospital from January 2018 to June 2023,were collected.The intraoperative and postoperative outcomes of the patients in the two groups were compared after propensity score matching(PSM).Statistical analysis was conducted using SPSS 26.0 software,with a test level of α=0.05.Results After PSM,there were 409 patients in the endoscopic group and 421 patients in the open group.There were no statistically significant differences in the baseline data between the two groups(P>0.05),except for tumor location,vascular invasion,intraglandular dissemination,and preoperative levels of total triiodothyronine and thyroid hormone(P<0.05).Compared with the open group,the patients in the endoscopic group had less intraoperative blood loss(P<0.05),higher points of incision satisfaction and cosmetic effect(P<0.05),but the number of lymph nodes dissected was less(P<0.05)and the operation time was longer(P<0.05)in the endoscopic group.The incidence of postoperative overall complications had no statistically significant difference between the endoscopic group and open group(3.6% versus 5.8%,P=0.127).There was no statistically significant difference in the recurrence rate between the endoscopic group and open group within one year of follow-up(0.2% versus 0.5%,P=0.099).Conclusions From the results of this study,the gasless endoscopic thyroidectomy is safety and reliability in treatment of PTC.It can achieve the same effect as traditional open thyroidectomy.However,it can also be seen that young female patients are more willing to choose gasless endoscopic thyroidectomy as long as their condition permits(such as early tumor stage,low invasiveness).

关 键 词：无充气 经腋窝入路 腔镜甲状腺手术 治疗效果 安全性 

分 类 号：R73[医药卫生—肿瘤]