无充气腋窝入路腔镜下单侧甲状腺癌根治术与开放性手术的疗效比较及对免疫功能和颈部功能的影响

摘要 目的：比较无充气腋窝入路腔镜下单侧甲状腺癌根治术与开放性手术的疗效及对免疫功能和颈部功能的影响。方法：回顾性分析我院2020年8月～2021年8月期间收治的行单侧甲状腺癌根治术患者80例的临床资料。根据手术方式的不同将患者分为开放组（开放性手术）和腔镜组（无充气腋窝入路腔镜下单侧甲状腺癌根治术），例数分别为37例和43例。对比两组疗效、免疫功能、颈部功能、美容学满意度和并发症情况。结果：与开放组相比，腔镜组术中出血量更少，手术时间、住院时间更长，引流液总量更多（P<0.05），两组中央组淋巴结清扫数组间对比无统计学差异（P>0.05）。两组CD3⁺、CD4⁺、CD4⁺/CD8⁺下降，但腔镜组高于开放组；CD8+升高，但腔镜组低于开放组（P<0.05）。两组术后3d视觉疼痛模拟评分法（VAS）评分、颈部损伤指数对比，差异无统计学意义（P>0.05）。腔镜组吞咽障碍指数低于开放组（P<0.05）。腔镜组的总满意率高于开放组（P<0.05）。两组并发症发生率组间对比无统计学差异（P>0.05）。结论：与开放性手术治疗单侧甲状腺癌相比，无充气腋窝入路腔镜下单侧甲状腺癌根治术的手术时间和住院时间虽然延长，但其对患者免疫功能影响更轻，同时还可减轻患者吞咽障碍，获得更好的美容学满意度。

Comparison of Curative Effect between Endoscopic Radical Thyroidectomy and Open Surgery through Non Inflatable Axillary Approach and its Effect on Immune Function and Neck Function

ABSTRACT Objective: To compare the efficacy of endoscopic radical thyroidectomy and open surgery through non inflatable axillary approach and its effect on immune function and neck function. Methods: The clinical data of 80 patients with unilateral radical thyroidectomy from August 2020 to August 2021 were analyzed retrospectively. According to the different operation methods, the patients were divided into open group (open operation) and endoscopic group (endoscopic radical thyroidectomy through non inflatable axillary approach). The number of cases were 37 and 43 respectively. The curative effect, immune function, neck function, cosmetic satisfaction and complications were compared between the two groups. Results: Compared with the open group, the endoscopic group had less intraoperative bleeding, longer operation time and hospital stay, and more total drainage fluid (P<0.05). There was no significant difference in the number of lymph node dissections between the two groups (P>0.05). CD3⁺, CD4⁺, CD4⁺/ CD8⁺ decreased in the two groups, but higher in the endoscopic group than in the open group. CD8⁺ increased, but it was lower in endoscopic group than in open group (P<0.05). There was no significant difference in VAS score and neck injury index between the two groups (P>0.05). The dysphagia index of endoscopic group was lower than that of open group (P<0.05). The total satisfaction rate of endoscopic group was higher than that of open group (P<0.05). There was no significant difference in the incidence of complications between the two groups (P >0.05). Conclusion: Compared with open surgery in the treatment of unilateral radical thyroidectomy, although the operation time and hospital stay under endoscopic non inflatable axillary approach are longer, it has less impact on patients'' immune function, reduces patients'' swallowing disorder and obtains better cosmetic satisfaction.