经口腔前庭入路与经胸乳入路腔镜甲状腺微小乳头状癌手术的疗效及安全性对比研究

目的 探讨经口腔前庭入路与经胸乳入路腔镜甲状腺微小乳头状癌手术的疗效及安全性。方法 回顾性研究。纳入2017年6月—2019年6月南方医科大学附属南海医院甲状腺血管外科110例甲状腺微小乳头状癌患者的临床资料,其中男14例、女96例,年龄18~59(35.19±6.89)岁,均采用腔镜手术治疗。按照手术方法不同分为经口腔前庭入路组(经口组,55例)和经胸乳入路组(经胸乳组,55例)。比较两组患者基线资料、手术情况、手术前后C反应蛋白(CRP)和白细胞计数(WBC),以及手术并发症发生率、术后患者满意度及美观度。结果 两组患者性别、年龄、侧别、肿瘤直径等基线资料比较差异均无统计学意义(P值均＞0.05)。经口组患者顺利完成腔镜甲状腺手术,而胸乳组有3例中转开放手术。经口组患者中央淋巴结清扫时间、切口总长度、术后引流总量分别为(30.21±4.62)min、(0.28±0.07)cm和(50.26±16.03)mL,均低于经胸乳组患者的(35.52±6.91)min、(1.91±0.21)cm和(73.17±19.53)mL,差异均有统计学意义(t=4.696、54.465、6.648,P值均＜0.01)。经口组患者中央淋巴结清扫数目为(8.74±2.03)枚,多于经胸乳组患者的(5.31±1.22)枚,差异有统计学意义(t=10.518,P＜0.01)。两组患者手术前后CRP、WBC比较,差异均无统计学意义(P值均＞0.05)。经口组术后暂时性口唇麻木发生率为40.00%(22/55),高于经胸乳组的0.00%;经口组术后暂时性胸前壁局部麻木感发生率为0.00%,低于经胸乳组的21.15%(11/52):差异均有统计学意义(χ²=26.184、12.968, P值均＜0.01)。经口组患者满意度评分为(9.06±0.75)分、美观度评分为(9.21±0.63)分,均高于经胸乳组患者的(8.61±0.84)分和(7.81±1.13)分,差异均有统计学意义(t=2.926、7.972,P值均＜0.01)。结论 与经胸乳入路腔镜甲状腺手术相比,经口腔前庭入路清除中央淋巴结数目更多,用时更短,且在保证疗效的同时满足了患者的美容需求,患者满意度高,值得临床推广应用。

Comparative study on the curative effect and safety of endoscopic micro-papillary carcinoma thyroid surgery through oral vestibule and chest-breast approaches

Objective To explore the curative effect and safety of endoscopic thyroid micro-papillary carcinoma surgery through oral vestibule and chest-breast approaches. Methods The clinical data of 110 patients (14 males, 96 females) with thyroid micro-papillary carcinoma who were admitted to Nanhai Hospital Affiliate to Southern Medical University between June 2017 and June 2019 were retrospectively analyzed. Their average age was 18-59 (35.19±6.89) years. According to different surgical methods, they were divided into oral vestibule approach surgery group (trans-oral group, n=55) and chest-breast approach surgery group (trans-chest-breast group, n=55). Baseline data, surgical situation, C-reactive protein (CRP), white blood cell count (WBC), incidence of complications, satisfaction, and aesthetics before and after surgery of the groups were compared. Results No significant differences in baseline data (gender, age, patient, and tumor diameter) were observed between the groups (all P values＞0.05). Endoscopic thyroid surgery was successfully completed in trans-oral group, while 3 patients in trans-chest-breast group were transferred to open surgery. The dissection time of central lymph nodes, total length of incision, and postoperative drainage volume in the trans-oral group were (30.21±4.62) min, (0.28±0.07) cm, and (50.26±16.03) mL, respectively, which were lower than those in the trans-chest-breast group (35.52±6.91] min, 1.91±0.21] cm, and 73.17±19.53] mL, respectively; t=4.696, 54.465, and 6.648; all P values＜0.01). The dissection number of central lymph nodes in trans-oral group was higher than that in the trans-chest-breast group (8.74±2.03 vs. 5.31±1.22, t=10.518, P＜0.01). After surgery, no significant differences in CRP and WBC were observed between the two groups (all P values＞0.05). The incidence of temporary lips numbness in the trans-oral group was higher than that in the trans-chest-breast group (40.00% vs. 0.00%), whereas the incidence of temporary local numbness in the anterior chest wall was lower than that in the trans-chest-breast group (0.00% vs. 21.15%, all P values=0.000). The scores of satisfaction and aesthetics in the trans-oral group were (9.06±0.75) points and (9.21±0.63) points, higher than those in the trans-chest-breast group (8.61±0.84] points and 7.81±1.13] points, respectively; t=2.926, 7.972; all P values＜0.01). Conclusions The number of removed central lymph nodes was higher and spending time was shorter with endoscopic thyroid surgery through oral vestibule approach than those achieved with endoscopic thyroid surgery through chest-breast approach. Thus, endoscopic thyroid surgery through oral vestibule approach can meet the cosmetic needs of patients and ensures a curative effect, thereby guaranteeing high patient satisfaction.