不同入路腔镜手术治疗甲状腺微小乳头状癌临床疗效比较的回顾性研究

摘要 目的：回顾性对比经胸乳入路、经口腔前庭入路两种入路方式治疗甲状腺微小乳头状癌（PTMC）的疗效。方法：回顾性分析南方医科大学附属南海医院甲状腺血管外科2019年1月-2021年6月期间接收的141例单侧PTMC患者的临床资料。按照入路方式的不同将患者分为A组（n=83，经胸乳入路）和B组（n=58，经口腔前庭入路），对比两组患者的创伤应激指标、手术相关指标、美容满意度、并发症及随访预后情况。结果：B组的手术时间长于A组，中央区淋巴结清扫数目多于A组，术后第1 d引流量、术中出血量少于A组，术后第1 d颈部VAS评分、切口总长度小于A组，术后住院时间短于A组（P<0.05）。术前、术后2 d，两组白细胞计数（WBC）、C反应蛋白（CRP）、前列腺素E₂（PGE₂）、皮质醇（Cor）水平组间对比无差异（P>0.05）；两组术后2 d，WBC、PGE2、CRP、Cor水平均较术前升高（P<0.05）。B组的美容满意率高于A组（P<0.05）。两组并发症发生率组间对比无差异（P>0.05）。术后随访1年，两组患者的死亡率、复发率、颈部淋巴结转移率均为0，组间对比无差异（P＞0.05）。结论：经口腔前庭入路可获得与经胸乳入路治疗PTMC相当的手术疗效，但经口腔前庭入路清除中央淋巴结数目更多，创伤小，术后疼痛轻，同时美容满意度更高。

Retrospective Study on the Clinical Efficacy Comparison of Endoscopic Surgery through Different Approaches in the Treatment of Papillary Thyroid Microcarcinoma

ABSTRACT Objective: To retrospectively compare the clinical efficacy of transoral oral vestibular approach and transthoracic breast approach in the treatment of papillary thyroid microcarcinoma (PTMC). Methods: The clinical data of 141 patients with unilateral PTMC who were admitted to Department of Thyroid and Vascular Surgery, Nanhai Hospital Affiliated to Southern Medical University from January 2019 to June 2021 were retrospectively analyzed. The patients were divided into group A (n=83, transthoracic breast approach) and group B (n=58, transoral oral vestibular approach) according to the different approaches. The operation-related indicators, traumatic stress indicators, cosmetic satisfaction, complications and follow-up prognosis were compared in the two groups. Results: The operation time in the group B was longer than that in the group A, the number of central lymph nodes dissected was more than that in the group A, the drainage volume on 1 d after operation and intraoperative blood loss were less than those in the group A, the neck VAS score on 1 d after operation and the total length of incision were less than those in the group A, and the postoperative hospital stay was shorter than that in the group A (P<0.05). There were no significant differences in white blood cell count (WBC), C-reactive protein (CRP), prostaglandin E₂ (PGE₂) and cortisol (Cor) between the two groups before operation and 2 d after operation (P>0.05). 2 d after operation, the levels of WBC, PGE₂, CRP and Cor in the two groups were significantly higher than those before operation, and the differences were statistically significant (P<0.05). The cosmetic satisfaction rate in the group B was higher than that in the group A (P<0.05). There was no difference in the incidence of complications in the two groups (P>0.05). At 1-year postoperative follow-up, the rates of death, recurrence, and cervical lymph node metastasis were 0 in both groups, with no differences between the two groups (P>0.05). Conclusion: Transoral oral vestibular approach can achieve the same surgical effect as transthoracic breast approach in the treatment of PTMC. However, transoral oral vestibular approach removes more central lymph nodes, has less trauma, less postoperative pain, and has a higher cosmetic satisfaction.