无充气腋窝入路完全腔镜下甲状腺癌根治术对术后颈部功能影响的初步研究

目的比较无充气腋窝入路完全腔镜下手术和传统开放手术治疗甲状腺乳头状癌(papillary thyroid carcinoma, PTC)对患者术后颈部疼痛不适和吞咽功能的影响。方法前瞻性纳入2018年7月至2018年12月浙江省肿瘤医院头颈外科由同一经验丰富的外科医师实施的传统开放手术(n=69)或无充气腋窝入路完全腔镜下手术(n=48)治疗的PTC女性患者共117例,术后3 d和6个月接受颈部疼痛评分,颈部损伤指数和吞咽障碍指数问卷调查,术后6个月进行手术瘢痕评估和美容效果满意度评分。应用SPSS 20.0进行统计分析,率或构成比比较采用χ2检验或精确概率法,样本均数差别的显著性检验采用方差分析。结果术后3 d,开放手术组和腋窝腔镜手术组颈部疼痛评分分别为(2.13±1.07)和(2.31±1.07)(P=0.368);颈部损伤指数分别为(5.13±3.02)和(5.31±3.00)(P=0.748);吞咽障碍指数分别为(5.49±3.47)和(3.77±2.96)(P=0.006)。术后6个月,开放手术组和腋窝腔镜手术组颈部疼痛评分分别为(0.52±0.61)和(0.60±0.74)(P=0.510),颈部损伤指数分别为(2.10±1.71)和(2.38±2.35)(P=0.467);吞咽障碍指数分别为(2.68±2.36)和(1.81±1.83)(P=0.034)。结论初步研究表明,无充气腋窝入路完全腔镜下甲状腺癌根治术对术后颈部不适和疼痛影响与开放手术相仿,但对吞咽功能影响较小。

Preliminary evaluation of neck function in patients with papillary thyroid carcinoma after endoscopic thyroidectomy using the gasless axillary approach

Objective To compare the postoperative neck pain,discomfort and swallowing difficulty in patients with papillary thyroid cancer(PTC)after conventional open thyroidectomy(COT)and endoscopic thyroidectomy using the gasless unilateral axillary approach(ET-UA).Methods The study included 117 female patients with PTC who underwent unilateral thyroid lobectomy plus central neck dissection using COT(n=68)or ETUA(n=48)performed by the same experienced surgeon.Subjective neck pain,discomfort and swallowing alterations were assessed by questionnaire 3 day and 6 months postoperatively.Surgical scar and cosmetic satisfaction evaluation were implemented 6 months postoperatively.SPSS 20.0 was used for statistical analysis,the rate or composition ratio was compared by the*2 test or the exact probability method,and the significance test of the difference in sample means was tested by analysis of variance.Results Three days after surgery,the neck pain scores of COT group and ET-UA group were(2.13±1.0)and(2.31±1.07)(P=0.368);the neck injury index was(5.13±3.02)and(5.31±3.00)(P=0.748);the dysphagia index was 5(0.49±3.47)and(3.77±2.96)(P=0.006).At 6 months postoperatively,the neck pain scores in COT group and ET-UA group group were(0.52±0.61)and(0.60±0.74)(P=0.510);the neck injury index was(2.10±1.71)and(2.38±2.35)(P=0.467);the dysphagia index was(2.68±2.36)and(1.81±1.83)(P=0.034),respectively.Conclusion Our preliminary study shows that there is no significant differences in postoperative neck pain or discomfort between COT groups and ET-UA group,whereas the impact of ET-UA on swallow function is relatively small than COT.