经腋窝入路免充气腔镜甲状腺手术在中老年患者中的应用价值

背景与目的：近年来随着微创技术的不断更新以及人们对生活质量要求的不断提高，腔镜甲状腺手术逐渐普及应用，尤其受到年轻女性患者的青睐。对于中老年患者，临床上仍以开放手术为主，较多患者术后会出现皮瓣下垂，吞咽联动，异物感等情况，严重影响患者的生活。经腋窝入路免充气腔镜手术利用颈部肌肉的自然间隙建腔，在颈前带状肌深面显露甲状腺并进行手术操作，对颈部功能影响较小，而且不需要CO2，对心肺影响较小。本研究探讨经腋窝入路免充气腔镜甲状腺手术在中老年患者中的疗效及安全性，为其在中老年患者中的应用提供参考。方法：回顾性分析2021年1月—2022年6月江苏省宿迁市第一人民医院甲乳外科收治的56例中老年甲状腺癌患者的临床资料。其中，26例接受经腋窝入路免充气腔镜下甲状腺手术（观察组），30例接受传统开放手术（对照组）。比较两组患者手术指标、疼痛状况、颈部损伤指数、吞咽障碍指数、并发症及预后。结果：56例患者均顺利完成手术。观察组手术时间长于对照组，术后引流量多于对照组（均P<0.05）。两组患者术中出血、呼吸困难、声音嘶哑、手足麻木、饮水呛咳、皮下血肿等并发症，中央区清扫淋巴结数，住院时间差异均无统...

Application value of gasless endoscopic thyroid surgery via axillary approach in middle-aged and elderly patients

Background and Aims In recent years, with the continuous advancement of minimally invasive technology and the increasing demand for quality of life, endoscopic thyroid surgery has gradually become popular and is particularly favored by young female patients. For middle-aged and elderly patients, open surgery still dominates in clinical practice, and many patients may experience postoperative complications such as flap sagging, swallowing difficulties, and foreign body sensation, which can significantly impact their daily lives. The gasless transaxillary endoscopic thyroid surgery technique utilizes the natural gaps between neck muscles to create a working space, allowing for exposure and surgical manipulation of the thyroid gland beneath the deep surface of the sternocleidomastoid muscle. This approach has minimal impact on neck function and does not require CO₂, resulting in reduced effects on the cardiovascular and respiratory systems. This study aims to explore the efficacy and safety of gasless transaxillary endoscopic thyroid surgery in middle-aged and elderly patients, providing a reference for its application in this patient population.Methods The clinical data of 56 middle-aged and elderly patients with thyroid cancer admitted to the First People''s Hospital of Suqian from January 2021 to June 2022 were retrospectively analyzed. Among them, 26 cases underwent gasless transaxillary endoscopic thyroid surgery (observation group), and 30 cases underwent traditional open surgery (control group). The surgical variables, pain status, neck injury index, swallowing disorder index, complications, and prognosis were compared between the two groups of patients.Results All 56 patients successfully underwent the surgery. The observation group had longer operative time and higher postoperative drainage volume compared to the control group (both P<0.05). There were no statistically significant differences between the two groups in terms of intraoperative bleeding, dyspnea, hoarseness, numbness in the extremities, coughing while drinking, subcutaneous hematoma, the number of resected central lymph nodes, and length of hospital stay (all P>0.05). The incidence rates of postoperative complications such as neck flap sagging, adhesions, swallowing linkage, pain and numbness, and foreign body sensation were significantly lower in the observation group than those in the control group (all P<0.05). Follow-up was conducted for 6 to 24 months in both groups, and no cases of recurrence or metastasis were observed.Conclusion Gasless transaxillary endoscopic thyroid surgery demonstrates good efficacy and safety in middle-aged and elderly patients with thyroid cancer. It significantly reduces postoperative complications such as neck skin sagging, adhesions, swallowing linkage, pain and numbness, and foreign body sensation. Furthermore, it improves the quality of life for patients. Therefore, this surgical technique has certain clinical application value.