Comparison of therapeutic effects between modified Miccoli surgery and total laparoscopic surgery via axillary approach in treatment of differentiated thyroid cancer
Comparison of therapeutic effects between modified Miccoli surgery and total laparoscopic surgery via axillary approach in treatment of differentiated thyroid cancer
宋传伟 1刘兆芳 2刘兆琳1
扫码查看
点击上方二维码区域，可以放大扫码查看
作者信息
1. 菏泽市立医院 乳甲外科,山东 菏泽 274000
2. 菏泽市立医院 耳鼻咽喉头颈外科,山东 菏泽 274000
折叠
摘要
目的:探究并分析改良Miccoli术与经腋窝入路全腔镜手术治疗分化型甲状腺癌的疗效差异.方法:选取2021年12月—2023年12月菏泽市立医院诊治的分化型甲状腺癌患者97例,进行前瞻性研究.采用随机数字表法分为改良Miccoli术组48例与经腋窝入路全腔镜手术组49例,比较两组手术指标、疼痛程度(VAS评分)、炎症因子、美学效果(VSS评分)、并发症发生情况的差异.结果:两组淋巴结清除数量相近,差异无统计学意义(P>0.05).相较于经腋窝入路全腔镜手术组,改良Miccoli术组展现出更短的手术时间、术后拔管时间、颈部恢复活动时间及住院时间,同时术中出血量更少(P<0.05).重复测量方差分析显示,两组VAS评分在时间、组间及交互效应上差异均有统计学意义(P<0.05),且随着时间的推移,两组VAS评分均有所降低(P<0.05),且改良Miccoli术组术后12、24 h VAS评分均低于经腋窝入路全腔镜手术组(P<0.05).与术前相比,术后7 d两组血管内皮生长因子(VEGF)均降低,肿瘤坏死因子-α(TNF-ɑ)、C反应蛋白(CRP)均升高(P<0.05);且改良Miccoli术组升高降低程度优于经腋窝入路全腔镜手术组(P<0.05).改良Miccoli术组美学效果评价中,厚度得分、血管分布得分、色素沉着得分、柔韧度得分、VSS总分均高于经腋窝入路全腔镜手术组(P<0.05),其美学效果不佳.两组并发症总发生率比较差异无统计学意义(P>0.05).结论:相较于经腋窝入路全腔镜手术,改良Miccoli术治疗分化型甲状腺癌损伤更小,术后恢复更快,且术后疼痛程度更低,但其美学效果不佳,两者安全性均较好.
Abstract
Objective:Explore and analyze the differences in therapeutic effects between modified Miccoli surgery and total laparoscopic surgery via axillary approach in the treatment of dif-ferentiated thyroid cancer. Methods:A total of 97 patients with differentiated thyroid cancer treated in Heze Municipal Hospital between December 2021 and December 2023 were selected as the subjects of this prospective study. A random number table method was used to divide 48 cases into an improved Miccoli surgery group and 49 cases into a total laparoscopic surgery group via axil-lary approach. The differences in surgical indicators,pain level (VAS score),inflammatory factors,aesthetic effect (VSS score),and incidence of complications between the two groups were com-pared. Results:The number of lymph node dissection between the two groups was similar,with no statistic difference (P>0.05). Compared to the group undergoing axillary total laparoscopic sur-gery,the modified Miccoli surgery group showed shorter surgical time,postoperative extubation time,neck recovery time,and hospital stay,as well as less intraoperative bleeding (P<0.05). Re-peated measures analysis of variance showed statistic difference (P<0.05) in VAS scores at time points,between groups,and interaction effects between the two groups. Over time,VAS scores in both groups decreased (P<0.05),and the modified Miccoli surgery group had lower VAS scores at 12 hours and 24 hours after surgery compared to the total laparoscopic surgery group via axillary approach (P<0.05). Compared with preoperative levels,both groups showed a decrease in vascular endothelial growth factor (VEGF) and an increase in tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) at 7 days postoperatively (P<0.05);and the degree of elevation and decrease in the modified Miccoli surgery group was better than that in the total laparoscopic surgery group via axillary approach (P<0.05). The thickness score,vascular distribution score,pigmentation score,flexibility score,and total VSS score of the modified Miccoli surgery group were higher than those of the total laparoscopic surgery group via axillary approach (P<0.05). There was no statistically sig-nificant difference in the incidence of complications between the two groups compared to the total incidence rate (P>0.05). Conclusion:Compared to total laparoscopic surgery via axillary ap-proach,the modified Miccoli procedure for treating differentiated thyroid cancer has less damage,faster postoperative recovery,and lower postoperative pain. However,its aesthetic effect is poor,and both methods are safe.
关键词
分化型甲状腺癌/改良Miccoli术/经腋窝入路全腔镜手术/疗效
Key words
Thyroid cancer differentiation type/Improved Miccoli technique/Total laparoscopic surgery through axillary approach/Curative effect
维普
万方数据