经口腔前庭和全乳晕入路腔镜治疗甲状腺乳头状癌的近期疗效分析#br#

目的探究经口腔前庭入路腔镜甲状腺手术和经全乳晕入路腔镜甲状腺手术治疗甲状腺乳头状癌的近期疗效。方法选取青岛大学附属烟台毓璜顶医院2018年12月至2019年12月66例cT1N0期甲状腺乳头状癌患者，根据术式的不同分为经口腔前庭入路腔镜手术组（口腔组）和全乳晕入路腔镜手术组（全乳晕组），各33例，对比2组近期疗效。结果口腔组与全乳晕组性别、年龄、病程、肿瘤位置、肿瘤直径比较，差异无统计学意义（P>005）。两组术中出血量、手术时间、中央区淋巴结清扫数、术后引流量、住院时间、颈部恢复活动时间比较差异无统计学意义（P>005），口腔组中央区淋巴结清扫时间短于全乳晕组，差异具有统计学意义（P<005）。两组术前及术后2 d红细胞沉降率（ESR）、白细胞计数（WBC）、C反应蛋白（CRP）、血钙、甲状旁腺素（PTH）水平比较，差异无统计学意义（P>005）。两组术后1 d、7 d的视觉模拟疼痛评分（VAS）比较，差异无统计学意义（P>005），术后2 d的VAS评分、温哥华瘢痕评定量表（VSS）评分及患者满意度评分比较，差异具有统计学意义（P<005）。两组术后CO2气体栓塞、喉返神经损伤、声嘶、感染、手足麻木、呛咳并发症的发生率比较，差异无统计学意义（P>005）。术后1年随访，两组是否需要接受I131治疗及局部复发率比较，差异无统计学意义（P>005）。结论经口腔前庭和全乳晕入路腔镜治疗cT1N0期甲状腺乳头状癌均安全有效，但前者术式清扫淋巴结数目用时更短，患者术后疼痛轻，美容效果更好，尤其对于有美容需求的患者可作为优先选择手术方式。

Analysis of short-term curative effect of endoscopic treatment of papillary thyroid carcinoma through oral vestibular and full areola approach

To explore the short-term effects of endoscopic thyroid surgery via oral vestibular approach and endoscopic thyroid surgery via full areola approach in the treatment of papillary thyroid carcinoma. Methods From December 2018 to December 2019, 66 patients with cT1N0 stage thyroid papillary carcinoma were selected in our hospital. According to the different surgical procedures, they were divided into transoral vestibular approach endoscopic surgery group (oral group) and full areola approach endoscopic surgery Surgery group (full areola group), 33 cases in each group, and the short-term efficacy of the two groups were compared. Results There was no significant difference in gender, age, course of disease, tumor location, and tumor diameter between the oral group and the full areola group (P>0.05). There was no significant difference in operation time, intraoperative blood loss, central lymph node dissection, postoperative drainage, hospital stay, and neck recovery time between the two groups (P>0.05). The central lymph node dissection time in the oral group was significantly shorter In the full areola group, the difference was statistically significant (P<0.05). There was no significant difference in erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell count (WBC), blood calcium, and parathyroid hormone (PTH) levels before and 2 days after operation between the two groups (P>0.05) ). There was no statistically significant difference in visual analogue pain score (VAS) between the two groups at 1 and 7 days after operation (P>0.05). There was no significant difference in VAS score, Vancouver Scar Rating Scale (VSS) score and patient satisfaction score at 2 days after operation. It is statistically significant (P<0.05). There was no significant difference in the incidence of postoperative complications of CO2 gas embolism, recurrent laryngeal nerve injury, hoarseness, infection, numbness of hands and feet, and coughing between the two groups (P>0.05). At 1-year follow-up, there was no significant difference in whether the two groups received I131 treatment and the local recurrence rate (P>0.05).Conclusion The endoscopic treatment of cT1N0 stage thyroid papillary carcinoma via oral vestibular and full areola approach is safe and effective, but the former requires less time for surgical removal of lymph nodes, less postoperative pain, and better cosmetic results, especially for patients with cosmetic needscan choose as the preferred surgical method.