摘要
目的 探讨经乳晕入路腔镜甲状腺手术(areola approach endoscopic thyroidectomy,AET)与无充气腋窝入路腔镜甲状腺手术(gasless axillary approach endoscopic thyroidectomy,GAET)治疗甲状腺乳头状癌(papillary thyroid carcinoma,PTC)患者的临床效果.方法 选取2019年5月至2022年5月临沂市人民医院甲状腺外科PTC患者96例,按照随机数字表法分为乳晕组(采取AET)和腋窝组(采取GAET),各48例.比较两组手术情况、术后恢复情况、手术前后相关生化指标[白细胞计数(white blood cell count,WBC)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)、甲状旁腺素(parathyroid hormone,PTH)、血钙]水平、术后疼痛程度、不适感程度、颈部功能及并发症.结果 腋窝组手术时间、拔管时间分别为(125.71±15.73)min、(3.12±0.53)d,均短于乳晕组的(137.94±20.02)min、(3.48±0.46)d;术中出血量为(14.19±4.16)mL,少于乳晕组的(22.65±7.39)mL;清扫淋巴结为(5.06±1.02)个,多于乳晕组的(4.23±1.14)个(P＜0.05);两组术后引流量、住院时间差异无统计学意义(P＞0.05).腋窝组术后1 d及3 d外周血WBC为(5.69±0.15)、(5.52±0.14)×109/L,ESR 为(8.21±0.55)、(7.64±0.60)mm/h,CRP 为(10.06±1.78)、(8.93±1.33)ng/L,低于乳晕组的(5.83±0.21)、(5.70±0.23)×109/L,(8.87±0.74)、(8.19±0.68)mm/h,(12.45±1.90)、(10.45±1.50)ng/L(P＜0.05),术后5 d上述生化指标水平差异无统计学意义(P＞0.05).两组术后1 d、3 d及5 d外周血PTH、血钙水平差异无统计学意义(P＞0.05).腋窝组术后1 d、3 d及5 d疼痛程度为(3.25±0.32)、(2.53±0.27)、(1.82± 0.22)分,不适感程度为(6.85±0.71)、(5.24±0.66)、(3.51±0.57)分,低于乳晕组的(3.78±0.40)、(2.89±0.34)、(2.06±0.26)、(7.46±0.84)、(6.09±0.73)、(4.16±0.60)分(P＜0.05).腋窝组术后 3 d颈部前屈、侧屈、后伸活动度分别为(33.16±3.09)°、(27.63±2.57)°、(30.44±2.73)°,均大于乳晕组的(30.08±2.76)°、(25.14±2.30)°、(27.98±2.54)°;吞咽障碍指数为(30.16±4.97)分,小于乳晕组的(34.83±4.13)分(P＜0.05);腋窝组并发症发生率为4.17％(2/48),低于乳晕组的16.67％(8/48).结论 GAET治疗PTC患者能提高清扫淋巴结效果,减轻手术创伤程度、术后疼痛感及不适感,还能加快术后早期颈部功能恢复,减少并发症.
Abstract
Objective To explore the clinical efficacy of areola approach endoscopic thyroidectomy(AET)and gasless axillary approach endoscopic thyroidectomy(GAET)in the treatment of papillary thyroid carci-noma(PTC)patients.Methods A total of 96 PTC patients from the Thyroid Surgery Department of Linyi People's Hospital from May.2019 to May.2022 were selected and randomly divided into 48 patients using a random num-ber table method.The areola group received AET,while the armpit group received GAET.The surgical situation,postoperative recovery,relevant biochemical indicators[white blood cell count(WBC),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),parathyroid hormone(PTH),blood calcium]before and after surgery,post-operative pain level,discomfort level,neck function,and complications were compared between the two groups.Results The surgical time and extubation time of the armpit group were(125.71±15.73)minutes and(3.12± 0.53)days,respectively,which were shorter than those of the areola group(137.94±20.02)minutes and(3.48± 0.46)days.The intraoperative bleeding volume was(14.19±4.16)mL,which was less than that of the areola group(22.65±7.39)mL,and the number of lymph nodes cleaned was 5.06±1.02,which was more than that of the areola group(4.23±1.14)(P＜0.05);there was no significant difference in postoperative drainage volume and hospital stay between the two groups(P＞0.05);Peripheral blood WBC in the armpit group on the 1st and 3rd day after sur-gery[(5.69±0.15)×109/L,(5.52±0.14)]×109/L,ESR[(8.21±0.55)mm/h,(7.64±0.60)mm/h],CRP[(10.06± 1.78)ng/L,(8.93±1.33)ng/L]were lower than those in the areola group[(5.83±0.21)×109/L,(5.70±0.23)×109/L,(8.87±0.74)mm/h,(8.19±0.68)mm/h,(12.45±1.90)ng/L,(10.45±1.50)ng/L](P＜0.05).There was no signifi-cant difference in the levels of the above biochemical indicators 5 days after surgery(P＞0.05).There was no signif-icant difference in peripheral blood PTH and calcium levels between the two groups on the 1st,3rd,and 5th postop-erative days(P＞0.05).The pain level[(3.25±0.32)scores,(2.53±0.27)scores,(1.82±0.22)scores]and discom-fort level[(6.85±0.71)scores,(5.24±0.66)scores,(3.51±0.57)scores]in the axillary group were lower than those in the areola group[(3.78±0.40)scores,(2.89±0.34)scores,(2.06±0.26)scores,(7.46±0.84)scores,(6.09± 0.73)scores,(4.16±0.60)scores]on the 1st,3rd,and 5th postoperative days(P＜0.05).The neck flexion,lateral flexion,and extension range of motion in the axillary group on the 3rd day after surgery were(33.16±3.09)°,(27.63±2.57)°,and(30.44 2.73)°,respectively,which were greater than those in the areola group[(30.08± 2.76)°,(25.14±2.30)°,and(27.98±2.54)°],and the swallowing disorder index was(30.16±4.97)points lower than the(34.83±4.13)points in the areola group(P＜0.05).The incidence of complications in the axillary group was 4.17％(2/48),lower than the 16.67％(8/48)in the areola group.Conclusion GAET treatment for PTC pa-tients can improve the effect of lymph node dissection,reduce the degree of surgical trauma,postoperative pain and discomfort,accelerate early postoperative recovery of neck function,and reduce complications.
基金项目
山东省自然科学基金(ZR2019PA019)
山东省重点研发计划项目(2018GSF118191)
维普
万方数据