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

  目的  探讨无充气腋窝入路完全腔镜下甲状腺癌根治术可行性及安全性。  方法  选取2017年2月至4月浙江省肿瘤医院开展的无充气腋窝入路完全腔镜下和颈前切口甲状腺癌根治术各11例，比较两组临床特征、手术情况、术后并发症及美容满意程度。  结果  腔镜组平均年龄(35.6±2.6)岁较开放组(48.5±2.3)岁更年轻(P=0.002)，而性别比例、肿瘤直径比较差异无统计学意义(P＞0.05)；中央区清扫后平均淋巴结数目腔镜组(2.4±1.7)枚与开放组(2.8±1.6)枚比较差异无统计学意义(P＞0.05)；腔镜组平均手术时间(123.9±28.1) min和引流液量(145.9±81.8) mL均较开放组(48.6±9.8) min、(87.7±18.9) mL更多，两组比较有显著性差异(P＜0.01)，腔镜组延长约1 d住院日。两组患者术后并发症比较无显著性差异(P＞0.05)。除胸部疼痛在术后3天两组比较有显著性差异(P=0.002)外，其余时间颈胸部疼痛两组比较无显著性差异(P＞0.05)，腔镜组获得理想的美容满意度(P＜0.01)。  结论  无充气腋窝入路完全腔镜下甲状腺癌根治术安全、可行，美容效果极佳。 

Preliminary evaluation of effect of endoscopic thyroidectomy using the gasless unilateral axillary approach

  Objective  To determine the technical feasibility, intraoperative safety, and efficacy of endoscopic thyroidectomy using the gasless unilateral axillary approach.  Methods  We analyzed 11 patients diagnosed with papillary thyroid carcinoma who underwent an endoscopic thyroidectomy between February and April 2017 using a gasless unilateral axillary approach at the Department of Head and Neck Surgical Oncology, Zhejiang Cancer Hospital. Additionally, we compared the clinical features, early surgical outcomes, surgical complications and postoperative satisfaction of endoscopic thyroidectomy with those of 11 patients who underwent conventional open thyroidectomies during the same period. Result In the endoscopic group, the mean age of patients ((35.6±2.6) years was younger than that of the open thyroidectomy group [(48.5±2.3) years, (P=0.002)]. The endoscopic thyroidectomy (unilateral lobectomy) procedure was successfully completed in all patients. The rate of central compartment neck dissection was not different between the groups [(2.4±1.7) vs. (2.8±1.6), P > 0.05]. The operative time was longer and the amount of drainage was higher in the endoscopic than in the open group [(123.9±28.1) min vs. (48.6±9.8) min, P < 0.01; (145.9±81.8) mL vs. (87.7±18.9) mL, P < 0.01]. Everage length of hospitalizntion was 1 day longer in the endoscopic group. The complication rate was not statistically significantly different between the groups. The postoperative pain score of the neck and anterior chest was not different between the groups except the anterior chest pain score at day 3 after operation. The cosmetic satisfaction was greater in the endoscopic group (P < 0.01).  Conclusions  Endoscopic thyroidectomy using a gasless unilateral axillary approach for the management of selected patients presenting with papillary thyroid carcinoma is a safe, feasible, and cosmetically superior procedure.