摘要
目的比较经颏下前庭入路腔镜手术与传统开放手术治疗甲状腺乳头状癌(PTC)的临床效果,探讨其手术操作特点、肿瘤学安全性及美容效果。方法回顾性分析2021年9月至2024年3月收治100例单侧PTC患者的临床资料,按手术方式分为腔镜组(n=38)与开放组(n=62),分别行经颏下前庭入路腔镜和开放甲状腺癌根治术。比较两组手术相关指标、并发症、切口美容效果及患者生活质量。结果与开放组比较,腔镜组手术时间显著延长[(126.5±60.1)min vs.(67.7±23.9)min,P<0.001],术中出血量明显减少[(13.5±8.9)mL vs.(16.9±5.7)mL,P<0.05],淋巴结清扫数目显著增加[(9.3±3.5)枚vs.(6.2±5.8)枚,P<0.01],术后WBC及CRP均升高(P<0.05)。两组术中喉返神经监测信号衰减、甲状旁腺种植、术后住院时间、引流量及引流时间比较,均无统计学差异(P>0.05)。术后两组均未发生伤口感染、永久性喉返神经损伤、甲状旁腺功能减退。两组暂时性喉返神经损伤、暂时性甲状旁腺功能减退、淋巴瘘、饮水呛咳、皮下瘀斑、口角损伤、血肿、感觉异常以及并发症发生率比较,均无统计学差异(P>0.05)。均随访12个月,均无复发或转移。腔镜组术后3个月温哥华瘢痕量表(VSS)评分显著低于开放组(3.7±0.9 vs.8.1±1.6),术后1年EORTC QLQ-C30评分显著高于开放组(80.4±7.1 vs.64.3±10.9),差异均有统计学意义(P<0.001)。结论经颏下前庭入路腔镜甲状腺癌根治术在保证肿瘤根治效果的同时,通过直视下游离隧道、视角优化等技术,有效减少术中出血,提高淋巴结清扫效率,其切口隐蔽性可显著改善术后美容效果及患者生活质量,但需克服操作空间受限及学习曲线较长等难点,适用于对外观要求较高的年轻患者。
Objective To compare the clinical efficacy of transoral endoscopic thyroidectomy via the submental-vestibular approach(TOETSMVA)and conventional open thyroidectomy for the treatment of papillary thyroid carcinoma(PTC),and to evaluate the operative characteristics,oncological safety,and cosmetic outcomes.Methods A retrospective analysis was conducted on the clinical data of 100 patients with PTC treated between September 2021 and March 2024.Based on the surgical approach,the patients were divided into the endoscopic group(n=38)and the open surgery group(n=62).The endoscopic group underwent TOETSMVA,while the open surgery group received conventional open radical thyroidectomy.Perioperative out-comes,postoperative complications,cosmetic results,and quality of life were compared between the two groups.Results Compared with the open group,the operation time was significantly longer[(126.5±60.1)min vs.(67.7±23.9)min,P<0.001],the intraoperative blood loss was lower[(13.5±8.9)mL vs.(16.9±5.7)mL,P<0.05],and the number of lymph nodes dissected was greater[(9.3±3.5)vs.(6.2±5.8),P<0.01]in the endoscopic group.The postoperative inflammatory indicators(WBC and CRP)were higher in the endoscopic group than in the open group(P<0.05).There was no significant difference in the incidence of intraoperative recurrent laryngeal nerve monitoring signal attenuation,parathyroid autotransplantation,postoperative hospital stay,drainage volume,or drainage duration between the two groups(P>0.05).No wound infection,perma-nent recurrent laryngeal nerve injury,or permanent hypoparathyroidism were observed in either group after surgery.There was no significant difference in the incidence of temporary recurrent laryngeal nerve injury,temporary hypoparathyroidism,lymphatic fistula,postoperative coughing on fluid intake,subcutaneous ecchymosis,oral commissure injury,hematoma,paresthesia,or overall complication rate between the two groups(P>0.05).All patients were followed up for 12 months,with no recurrence or metastasis observed.The endoscopic group exhibited significantly lower Vancouver Scar Scale(VSS)scores at 3 months postoperatively(3.7±0.9 vs.8.1±1.6,P<0.001)and higher EORTC QLQ-C30 scores at 1 year postoperatively(80.4±7.1 vs.64.3±10.9,P<0.001).Conclusions TOETSMVA achieves comparable oncological outcomes while reducing intra-operative bleeding and enhancing the efficiency of lymph node dissection through techniques such as tunneling dissection and optimized visualization under direct vision.The concealed incision significantly improves post-operative cosmetic outcomes and patient quality of life.However,surgeons must overcome challenges such as a restricted operating space and a long and steep learning curve.The procedure is particularly suitable for young patients with high cosmetic demands.
作者
陈念
倪志强
董宇轩
徐添旺
彭书旺
CHEN Nian;NI Zhiqiang;DONG Yuxuan;XU Tianwang;PENG Shuwang(Department of Thyroid Surgery,The First Hospital of Hunan University of Chinese Medicine,Changsha 410007,Hunan,China)
出处
《中国现代手术学杂志》
2025年第3期171-177,共7页
Chinese Journal of Modern Operative Surgery
基金
湖南省教育厅科学研究项目(2022B0402)。
