摘要
目的 分析经腋无充气腔镜、经口前庭无充气腔镜、颈部开放手术治疗甲状腺乳头状癌的疗效.方法 回顾性分析2020年8月-2022年12月商丘市第一人民医院行手术治疗的98例甲状腺乳头状癌患者的临床治疗,其中经腋无充气腔镜手术29例(A组)、经口前庭无充气腔镜33例(B组)、传统颈部开放手术36例(C组),比较3组的手术相关指标、颈部功能、免疫功能,术后3个月患者的疤痕情况及术后并发症情况.结果 A组、B组术中出血量分别为(18.3±2.8)、(30.2±4.2)ml,少于 C组的(37.0±13.6)ml;手术时间分别为(126.4±9.2)、(191.0±60.1)min,长于 C 组的(73.8±6.3)min;引流液量为(91.8±5.4)、(85.2±6.1)ml,多于C组的(52.7±7.3)ml,差异均有统计学意义(F=37.431、94.144、357.922,均P＜0.05).术后A组、B组吞咽障碍指数分别为(6.8±2.5)、(7.0±2.6)分,低于C组(12.6±3.5)分(P＜0.05).治疗后 3组的CD 4+(35.5±7.3、35.0±7.3、31.6±5.4)、CD 4+/CD 8+水平(1.4±0.4、1.4±0.4、1.0±0.3)下降、CD 8+水平(26.4±3.4、26.8±3.4、29.5±3.8)上升,并且 A 组、B 组改变幅度大于C组(P＜0.05).术后3个月,A组、B组Vancouver疤痕评定量表评分为(6.0±1.0)、(6.4±1.0)分,均低于C组(8.5±1.2)分(F=18.925,P＜0.05).结论 相对于颈部开放手术治疗甲状腺乳头状瘤,无充气经腋、经口前庭入路方式腔镜根治术对患者吞咽影响更轻,患者对外观美容满意度高,是安全有效的手术方式.
Abstract
Objective To analyze the efficacy of gasless unilateral axillary endoscopic approach,transoral vestibular endoscopic approach and open thyroidectomy for papillary thyroid carcinoma(PTC).Methods A retrospective analysis was made on 98 PTC patients who underwent surgical treatment at our hospital from Aug 2020 to Dec 2022,including 29 cases of transaxillary non pneumatic endoscopic surgery(group A),33 cases of oral vestibular non pneumatic endoscopic surgery(group B),and 36 cases of traditional open neck surgery(group C).The operation related indicators,neck function,immune function,scar condition and postoperative complications of the three groups were compared.Results The intraoperative blood loss(18.3±2.8),(30.2±4.2)ml in group A and group B was lower than that in group C(37.0±13.6)ml,the operation time(126.4±9.2)min,(191.0±60.1)min was longer than that in group C(73.8±6.3)min,and the drainage volume(91.8±5.4)ml,(85.2±6.1)ml was higher than that in group C(52.7±7.3)ml(F=37.431,94.144,357.922,all P＜0.05).The scores of dysphagia index(6.8±2.5,7.0±2.6)in group A and B were lower than those in group C(12.6±3.5)(P＜0.05).After treatment,surface antigen differentiation cluster 4+(35.5±7.3,35.0±7.3,31.6±5.4),surface antigen differentiation cluster 4+/surface antigen differentiation cluster 8+level(1.4±0.4,1.4±0.4,1.0±0.3)decreased,and surface antigen differentiation cluster 8+level(26.4±3.4,26.8±3.4,29.5±3.8)increased in the three groups,and the change amplitude in groups A and B was higher than that in group C(P＜0.05).At 3 months after operation,the VSS scores in group A and group B(6.0±1.0,6.4±1.0)were lower than those in group C(8.5±1.2)(F=18.925,P＜0.05).Conclusions Compared with open thyroidectomy for PTC,application of endoscopic thyroidectomy via gasless unilateral axillary or transoral vestibular approach has the advantage of a less swallowing impact and better patient satisfaction with cosmetic appearance,making it a safe and effective surgical procedure for clinical treatment of PTC.
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