摘要
目的探讨经腋窝入路或经口腔前庭入路腔镜甲状腺切除术在治疗颈淋巴结阴性(cN0期)单侧甲状腺乳头状癌中的应用价值。方法选取2020年1月—2023年6月收治的86例接受手术治疗的cN0期单侧甲状腺乳头状癌患者,按随机数字法分为对照组与观察组,每组各43例。对照组采用经口腔前庭入路腔镜甲状腺切除术,观察组则采用经腋窝入路腔镜甲状腺切除术,观察并比较两组患者手术时间、术中出血量、术后引流量、中央区淋巴结清扫数量、视觉模拟评分法(VAS)评分、并发症总发生率以及术后满意度。结果观察组患者术中出血量、术后引流量以及VAS评分均低于对照组(P<0.05),但中央区淋巴结清扫数量高于对照组(P<0.05),而两组患者手术时间、住院时间差异无统计学意义(P>0.05);观察组并发症总发生率(16.27%)与对照组(18.60%)间差异无统计学意义(P>0.05),但其术后满意度(97.67%)高于对照组(79.07%),差异有统计学意义(P<0.05)。结论经腋窝腔镜甲状腺切除术能更好地保护颈前功能区,且术后颈前不适感更少;经口腔前庭入路腔镜甲状腺切除术操作空间小,难度大,总体上手术时间较长,但美容效果更佳,术后感染的可能性比经腋窝入路大。因此,采用经腋窝腔镜甲状腺切除术治疗cN0期单侧甲状腺乳头状癌效果更好。
Objective To explore the application value of endoscopic thyroidectomy through axillary or oral vestibular approaches in the treatment of unilateral papillary thyroid carcinoma with negative cervical lymph nodes(cN0 stage).Methods A total of 86 patients with cN0 stage unilateral papillary thyroid carcinoma who underwent surgical treatment from January 2020 to June 2023 were randomly divided into a control group and an observation group,with 43 patients in each group.The control group underwent endoscopic thyroidectomy via the oral vestibular approach,while the observation group underwent endoscopic thyroidectomy via the axillary approach.The surgical time,intraoperative blood loss volume,postoperative drainage volume,number of central lymph node dissections,visual analog scale(VAS)score,total incidence of complications,and postoperative satisfaction were observed and compared between the two groups of patients.Results The intraoperative blood loss volume,postoperative drainage volume,and VAS score of the observation group were all lower than those of the control group(P<0.05),but the number of central lymph node dissection was higher(P<0.05).There was no statistically significant difference in surgical time and hospitalization time between the two groups of patients(P>0.05).There was also no statistically significant difference in the total incidence of complications between the observation group(16.27%)and the control group(18.60%)(P>0.05),but the postoperative satisfaction rate(97.67%)of the observation group was higher than that of the control group(79.07%),and the difference was statistically significant(P<0.05).Conclusion Transaxillary endoscopic thyroidectomy can better protect the anterior cervical functional area and reduce postoperative discomfort in the anterior neck.Comparably,transoral vestibular endoscopic thyroidectomy features smaller operating space,higher difficulty,overall longer surgical time,and higher risks of postoperative infection,despite better cosmetic effect.Therefore,transaxillary endoscopic thyroidectomy is more effective in the treatment of cN0 unilateral papillary thyroid carcinoma.
作者
高贵德
刘小华
陈金剑
陈福灯
涂兴峰
GAO Guide;LIU Xiaohua;CHEN Jinjian;CHEN Fudeng;TU Xingfeng(Department of Head,Neck,and Breast Surgery,Second Hospital of Longyan,Longyan 364000,Fujian,China)
关键词
甲状腺乳头状癌
腔镜甲状腺切除术
经腋窝入路
经口前庭入路
Papillary thyroid carcinoma
Endoscopic thyroidectomy
Transaxillary approach
Transoral vestibular approach
