Efficacy evaluation of transaxillary non-inflatable endoscopic surgery and open neck surgery in the treatment of PTC: a single center report of 342 cases
-
摘要: 目的 探讨经腋无充气腔镜辅助与颈部传统开放甲状腺手术治疗甲状腺乳头状癌(papillary thyroid carcinoma，PTC)的临床应用效果比较。方法 回顾性分析2020年12月至2022年12月山东大学齐鲁医院耳鼻咽喉科收治的采用单侧经腋无充气腔镜辅助甲状腺手术(腔镜组)与单侧传统开放甲状腺手术(开放组)共342例PTC患者的资料，其中男73例，女269例；年龄16~72岁。腔镜组108例，开放组234例。结果 腔镜组在年龄(37.1±9.4)岁、BMI指数(23.4±3.4) kg/m2小于开放组年龄(43.5±11.2)岁、BMI指数(25.7±3.8) kg/m2，差异有统计学意义(t分别为5.53、5.67，均P < 0.01)，2组患者住院天数比较，差异无统计学意义(P>0.05)；手术时长对数曲线呈现平滑下降趋势，腔镜组总体手术时长相对一致；腔镜组患者的术中出血量(13.3±3.2) mL与开放组(14.7±6.3) mL比较，差异无统计学意义(P>0.05)，但是手术时长(130.1±37.9) min多于开放组(57.4±13.7) min，差异有统计学意义(t=19.40，P < 0.01)；2组在术后3 d内出现暂时性喉返神经损伤等并发症方面比较，差异无统计学意义(P>0.05)；腔镜组患者对手术切口美观满意度评分及切口隐藏效果评分均高于开放组，差异有统计学意义(P < 0.05)。结论 经腋无充气腔镜辅助甲状腺手术相较于传统开放甲状腺手术在术后切口隐蔽性与美观度上更具优势，虽然前者手术时间更长，引流量更多，但其仍是安全可行且术后临床效果较好的手术方式。Abstract: Objective To compare the clinical effect of transaxillary non-inflatable endoscopic surgery and traditional open thyroid surgery in the treatment of PTC.Methods A retrospective analysis was performed on 342 patients with PTC treated in the Otorhinolaryngology Department of Qilu Hospital of Shandong University from December 2020 to December 2022. There were 73 males and 269 females, aged 16-72 years, who underwent unilateral non-inflatable transaxillary endoscopic thyroid surgery(endoscopic group) and unilateral traditional open thyroid surgery(open group). There were 108 patients in the endoscopic group and 234 in the open group.Results The endoscopic group was lower in age(37.1±9.4 vs 43.5±11.2) years and BMI(23.4±3.4 vs 25.7±3.8)kg/m2 than that in the open group, and the difference was statistically significant(t was 5.53, 5.67 respectively, P < 0.01). There was no significant difference in hospitalization days between the two groups(P>0.05). The logarithmic curve of the operation time showed a smooth downward trend, and the overall operation time of the endoscopic group was relatively consistent. There was no significant difference in intraoperative blood loss between the endoscopic group(13.3±3.2) mL and the open group(14.7±6.3) mL(P>0.05), but the operation time(130.1±37.9) min was longer than that in the open group(57.4±13.7) min, and the difference was statistically significant(t=19.40, P < 0.01). There was no significant difference in complications such as temporary recurrent laryngeal nerve injury within 3 days after operation between the two groups(P>0.05). The aesthetic satisfaction score of the surgical incision and the incision concealment effect score in the endoscopic group were higher than those in the open group, and the difference was statistically significant(P < 0.05).Conclusion Compared with traditional open thyroidectomy, transaxillary non-inflatable endoscopic thyroidectomy has more advantages in the concealment and aesthetics of postoperative incision. Although the former has longer operation time and more drainage, it is still a safe and feasible surgical method with good postoperative clinical effect.
-
Key words:
- thyroidectomy /
- surgery, minimally invasive /
- axillary approach /
- thyroid neoplasms
-
-
表 1 腔镜组与开放组患者资料基本情况比较
项目 腔镜组(n=108) 开放组(n=234) t/χ2/Z P 年龄/岁 37.1±9.4 43.5±11.2 5.53 < 0.01 性别/例(%) 26.27 < 0.01 男 5(4.6) 68(29.1) 女 103(95.4) 166(70.9) BMI/kg/m2 23.4±3.4 25.7±3.8 5.67 < 0.01 住院天数/d 6.2±1.2 6.1±1.2 0.08 0.93 病灶位置/例(%) 0.09 0.77 左 48(44.4) 100(42.7) 右 60(55.6) 134(57.3) 病灶数目/例(%) 0.99 0.68 1个 95(88.0) 200(85.5) 2个 13(12.0) 31(13.2) ≥3个 0 3(1.3) 肿瘤最大径/mm 6(4) 6(4) 1.75 0.08 原发肿瘤是否侵及被膜/例(%) 2.29 0.13 是(n=207) 59(54.6) 148(63.2) 否(n=135) 49(45.4) 86(36.8) 原发肿瘤T分期/例(%) — 0.29 T1a 97(89.8) 197(84.2) T1b 11(10.2) 30(12.8) T2 0 6(2.6) T3 0 1(0.4) N分期/例(%) 1.36 0.24 N0 84(77.8) 168(71.8) N1a 24(22.2) 66(28.2) 术前PTH水平/pg/mL 42.5±13.9 40.9±14.1 0.97 0.33 
下载: 导出CSV
表 2 腔镜组与开放组患者资料中手术相关项目比较
项目 腔镜组(n=108) 开放组(n=234) t/Z P 手术时长/ min 130.1±37.9 57.4±13.7 19.40 < 0.01 术中出血量/mL 13.3±3.2 14.7±6.3 4.92 0.73 清扫出淋巴结数/枚 3.4±2.3 3.8±2.8 4.60 0.61 转移淋巴结数/枚 0.4±1.3 0.6±1.1 1.07 0.32 术后24 h引流量/mL 44.5±20.6 25.1±11.9 11.40 < 0.01 总引流量/mL 65.2±25.2 33.8±13.8 14.70 < 0.01 引流天数/d 2(0) 2(0) 2.33 0.02 手术当天疼痛评分/分 2(0) 2(0) 1.94 0.06 出院时疼痛评分/分 2(1) 2(1) 0.62 0.54 疼痛评分使用疼痛评分数字评定量表(NRS)。
下载: 导出CSV
表 3 腔镜组与开放组患者术后并发症及主观评分比较
项目 腔镜组(n=108) 开放组(n=234) χ2/Z/t P 暂时性喉返神经损伤/例(%) 2(1.9) 3(1.3) 0.01 0.99 术后出血/例(%) 0 5(2.1) 1.09 0.29 术后感染/例(%) 0 0 - - 术后3 d 四肢麻木/例(%) 4(3.7) 9(3.8) 0.01 0.99 颈前皮肤麻木/例(%) 7(6.5) 11(4.7) 0.47 0.49 乳糜漏/例(%) 0 1(0.4) - 0.99 PTH水平/pg/mL 36.1±11.3 33.7±13.4 1.13 0.18 术后3个月 发音异常/例(%) - - 吞咽不适感/例(%) 2(1.9) 6(2.6) 0.01 0.98 颈前区不适/例(%) 5(4.6) 12(5.1) 0.04 0.84 腋区不适/例(%) 8(7.4) 0 14.65 < 0.01 颈部运动异常/例(%) 0 1(0.4) - 0.99 切口美观满意度/分 5(0) 5(1.0) 2.56 0.01 切口隐藏效果评分/分 3(0) 2(1.0) 10.99 < 0.01
下载: 导出CSV
-
[1] Megwalu UC, Moon PK. Thyroidcancer incidenceandmortalitytrends intheUnitedStates: 2000—2018[J]. Thyroid, 2022, 32(5): 560-570. doi: 10.1089/thy.2021.0662
[2] Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019[J]. CA Cancer J Clin, 2019, 69(1): 7-34. doi: 10.3322/caac.21551
[3] Berber E, Bernet V, Fahey TJ, et al. American Thyroid Association Statement on Remote-Access Thyroid Surgery[J]. Thyroid, 2016, 26(3): 331-337. doi: 10.1089/thy.2015.0407
[4] Anuwong A, Ketwong K, Jitpratoom P, et al. Safety and Outcomes of the Transoral Endoscopic Thyroidectomy Vestibular Approach[J]. JAMA Surg, 2018, 153(1): 21-27. doi: 10.1001/jamasurg.2017.3366
[5] Berber E, Bernet V, Fahey TJ 3rd, et al. American Thyroid Association Statement on Remote-Access Thyroid Surgery[J]. Thyroid, 2016, 26(3): 331-337. doi: 10.1089/thy.2015.0407
[6] 郑传铭, 徐加杰, 王佳峰, 等. 无充气腋窝入路腔镜甲状腺手术的进展与展望[J]. 中国普外基础与临床杂志, 2021, 28(10): 1266-1269. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWL202110022.htm
[7] Tae K, Ji YB, Song CM, et al. RoboticandEndoscopic ThyroidSurgery: Evolution and Advances[J]. Clin Exp Otorhinolaryngol, 2019, 12(1): 1-11. doi: 10.21053/ceo.2018.00766
[8] 郑传铭, 毛晓春, 王佳峰, 等. 无充气腋窝入路完全腔镜下甲状腺癌根治术效果初步评价初期体会[J]. 中国肿瘤临床, 2018, (1): 27-32. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZL201801009.htm
[9] 中国抗癌协会甲状腺癌专业委员会, 中华医学会肿瘤学分会甲状腺肿瘤专业委员会, 中国研究型医院学会甲状腺疾病专业委员会, 等. 无充气腋窝入路腔镜甲状腺手术专家共识(2022版)[J]. 中华内分泌外科杂志, 2021, 15(6): 557-563.
[10] 郑传铭, 徐加杰, 蒋烈浩, 等. 无充气腋窝入路完全腔镜下甲状腺叶切除的方法——葛-郑氏七步法[J]. 中国普通外科杂志, 2019, 28(11): 1336-1341. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWZ201911003.htm
[11] 万丽, 赵晴, 陈军, 等. 疼痛评估量表应用的中国专家共识(2020版)[J]. 中华疼痛学杂志, 2020, 16(3): 177-187.
[12] Lan Y, Luo Y, Zhang M, et al. Quality of Life in Papillary Thyroid Microcarcinoma Patients Undergoing Radiofrequency Ablation or Surgery: A Comparative Study[J]. Front Endocrinol(Lausanne), 2020, 11: 249.
[13] 陈孝磊, 李超, 周雨秋, 等. 经腋无充气腔镜与传统颈部开放手术治疗PTC的疗效分析[J]. 中华耳鼻咽喉头颈外科杂志, 2023, 58(4): 351-357.
[14] Russell JO, Razavi CR, Garstka ME, et al. Remote-Access Thyroidectomy: A Multi-Institutional North American Experience with Transaxillary, Robotic Facelift, and Transoral Endoscopic Vestibular Approaches[J]. J Am Coll Surg, 2019, 228(4): 516-522.
[15] 黄能为, 易茂林, 单华静, 等. 免充气经腋窝入路全腔镜下甲状腺手术对喉返神经功能的影响[J]. 实用医学杂志, 2021, 37(13): 1727-1731. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ202113017.htm
[16] 徐加杰, 张李卓, 张启弘, 等. 无充气经腋窝腔镜甲状腺手术的临床应用[J]. 中华耳鼻咽喉头颈外科杂志, 2020, 55(10): 913-920. https://www.cnki.com.cn/Article/CJFDTOTAL-XHON202105020.htm
[17] 梁国连, 张锡贵, 李祖设, 等. 无充气经腋窝入路腔镜手术对单侧甲状腺良性肿瘤患者颈部功能的影响研究[J]. 中国实用医药, 2022, 17(7): 99-101. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA202207034.htm
[18] 吴登东, 陈华锋, 罗宝莉, 等. 经腋窝入路腔镜甲状腺手术的临床研究[J]. 中国医药指南, 2022, 20(36): 42-45. https://www.cnki.com.cn/Article/CJFDTOTAL-YYXK202236011.htm
[19] Wang XF, Liu F, Zeng X, et al The learning curve ofgasless transaxillary endoscopic thyroidectomy inpatientswithpapillary thyroidmicocarcinoma[J]. Chin J Bases Clin Gen Surg, 2021, 28(10): 1270-1274.
-
图(1)
表(3)
计量
- 文章访问数: 946
- PDF下载数: 136
- 施引文献: 0