免充气腋径路腔镜与传统开放甲状腺手术的疗效对比分析

doi:10.16139/j.1007-9610.2023.01.14

摘要/Abstract

摘要：

目的：比较免充气腋径路腔镜与传统开放甲状腺手术的临床效果。方法：回顾性分析2015年8月至2020年7月瑞金医院卢湾分院普外科行单侧甲状腺全切除术的病人资料，按照手术方式分为两组，96例免充气腋径路腔镜单侧甲状腺手术(腔镜组)和232例传统开放单侧甲状腺手术(开放组)。比较两组手术相关指标、术后恢复相关指标及术后并发症发生率。结果： 腔镜组手术时间显著长于开放组[(168±23) min比(95±18) min，P=0.022]，术中喉返神经识别率两组差异无统计学意义（100.0%比99.1%，P=0.138），上、下甲状旁腺识别率腔镜组显著高于开放组（98.0%比97.0%；95.8%比99.1%，P=0.003、0.028）。术后首日引流量腔镜组显著高于开放组[(42±22) mL比(25±10) mL，P=0.006]，术后住院天数长于开放组[(2.8±0.6) d比(1.8±1.2) d，P=0.016]，住院费用两组差异无统计学意义[(13 186±1 015)元比(12 632±1 456)元，P=0.365]，总体并发症发生率两组差异无统计学意义(10.4%比9.1%，P=0.126)。 结论：免充气腋径路腔镜甲状腺手术安全可行，切口美观，但其手术手术时间和住院时间较长。

关键词: 腋径路, 腔镜, 甲状腺

Abstract:

Objective To compare the clinical efficacy between air-free trans-axillary laparoscopic thyroidectomy and open thyroidectomy. Methods A retrospective analysis was performed on the data of both 96 patients who underwent air-free trans-axillary laparoscopic thyroidectomy (laparoscopic group) and 232 patients who underwent open thyroidectomy (open group) from August 2015 to July 2020. Comparative analysis were performed on operative data, the postoperative data of recovery and complications between two groups. Results The operative time in laparoscopic group was longer significantly than that in open group [(168±23) min vs. (95±18) min, P=0.022]. There was no significantly difference in the rate of recognition of recurrent laryngeal nerve between two groups (100.0% vs. 99.1%, P=0.138). The rate of recognition of both superior (98.0% vs. 97.0%, P=0.003) and inferior parathyroid glands (95.8% vs. 99.1%, P=0.028) in laparoscopic group was higher significantly than those in open group. The amount of drain of the first day after operation in laparoscopic group was more significantly than that in open group[(42±22) mL vs. (25±10) mL, P=0.006]. The postoperative length of hospital stay in laparoscopic group was longer significantly [(2.8±0.6) d vs. (1.8±1.2) d, P=0.016]. The cost of hospital stay was (13 186±1 015) yuan vs. (12 632±1 456) yuan （P=0.365） and the rate of postoperative complication was 10.4% vs. 9.1%（P=0.126）, which all showed no significant difference between two groups. Conclusions Air-free trans-axillary laparoscopic thyroidectomy could be feasible and safe, and have better appearance. However, both operative time and hospital stay were longer.

Key words: Trans-axillary, Laparoscopy, Thyroid

中图分类号:

R653

廖文强, 李勤裕, 袁建明, 吴卫泽, 王明亮. 免充气腋径路腔镜与传统开放甲状腺手术的疗效对比分析[J]. 外科理论与实践, 2023, 28(01): 83-87.

LIAO Wenqiang, LI Qinyu, YUAN Jianming, WU Weize, WANG Mingliang. Comparative analysis between air-free trans-axillary laparoscopic thyroidectomy and open thyroidectomy[J]. Journal of Surgery Concepts & Practice, 2023, 28(01): 83-87.

图/表 2

参考文献 17

[1]	HÜSCHER C S, CHIODINI S, NAPOLITANO C, et al. Endoscopic right thyroid lobectomy[J]. Surg Endosc, 1997, 11(8):877. doi: 10.1007/s004649900476 pmid: 9266657
[2]	SUN H, ZHENG H, WANG X, et al. Comparison of transoral endoscopic thyroidectomy vestibular approach, total endoscopic thyroidectomy via areola approach, and conventional open thyroidectomy: a retrospective analysis of safety, trauma, and feasibility of central neck dissection in the treatment of papillary thyroid carcinoma[J]. Surg Endosc, 2020, 34(1):268-274. doi: 10.1007/s00464-019-06762-6
[3]	MICCOLI P, ELISEI R, MATERAZZI G, et al. Minimally invasive video-assisted thyroidectomy for papillary carcinoma: a prospective study of its completeness[J]. Surgery, 2002, 132(6):1070-1073. doi: 10.1067/msy.2002.128694 URL
[4]	谭玲珍, 许志亮, 宋俊龙, 等. 改良Miccoli腔镜辅助颈侧区清扫术与传统开放手术治疗分化型甲状腺癌的疗效对比分析[J]. 腹腔镜外科杂志, 2019, 24(4):245-248.
	TAN L Z, XU Z L, SONG J L, et al. Comparative effectiveness analysis of modified Miccoli endoscopic assisted neck lateral dissection and traditional open surgery for differentiated thyroid cancer[J]. J Laparoscopic Surg, 2019, 24(4):245-248.
[5]	梁明, 张亦磊, 王志杰, 等. 胸乳入路腔镜手术治疗甲状腺乳头状癌的临床研究[J]. 中华内分泌外科杂志, 2022, 16(1):75-79.
	LIANG M, ZHANG Y L, WANG Z J, et al. Clinical study of endoscopic surgery through thoraco mammary approach in treatment of thyroid papillary carcinoma[J]. Chin J Endocr Surg, 2022, 16(1):75-79.
[6]	YAN H C, XIANG C, WANG Y, et al. Scarless endoscopic thyroidectomy (SET) lateral neck dissection for papillary thyroid carcinoma through breast approach: 10 years of experience[J]. Surg Endosc, 2021, 35(7):3540-3546. doi: 10.1007/s00464-020-07814-y
[7]	李秀萍, 俞红梅, 徐志伟, 等. 改良无充气经腋窝腔镜甲状腺手术治疗甲状腺微小乳头状癌的疗效分析[J]. 中华内分泌外科杂志, 2021, 15(3):273-277.
	LI X P, YU H M, XU Z W, et al. Efficacy of the modified gasless unilateral axillary approach endoscopic thyroid surgery in the treatment of papillary thyroid microcarcinoma[J]. Chin J Endocr Surg, 2021, 15(3):273-277.
[8]	章德广, 何高飞, 高力, 等. 无充气颏下前庭联合入路腔镜甲状腺手术治疗甲状腺乳头状癌41例临床分析[J]. 中华外科杂志, 2022, 60(2):154-158.
	ZHANG D G, HE G F, GAO L, et al. Gasless submental-transoral combined appoach endoscopic thyroidectomy for papillary thyroid carcinoma: a series of 41 cases[J]. Chin J Surg, 2022, 60(2):154-158.
[9]	KASEMSIRI P, TRAKULKAJORNSAK S, BAMROONG P, et al. Comparison of quality of life between patients undergoing trans-oral endoscopic thyroid surgery and conventional open surgery[J]. BMC Surg, 2020, 20(1):18. doi: 10.1186/s12893-020-0685-3 pmid: 31996201
[10]	KANG Y J, CHO J H, STYBAYEVA G, et al. Safety and efficacy of transoral robotic thyroidectomy for thyroid tumor: a systematic review and meta-analysis[J]. Cancers (Basel), 2022, 14(17):4230. doi: 10.3390/cancers14174230 URL
[11]	JANTHARAPATTANA K, LEELASAWATSUK P. Transaxillary endoscopic thyroid lobectomy: gas insufflation versus gasless technique[J]. Eur Arch Otorhinolaryngol, 2020, 277(7):2049-2054. doi: 10.1007/s00405-020-05908-w
[12]	汪杰. 腔镜甲状腺手术的临床应用进展[J]. 腹腔镜外科杂志, 2021, 26(9):711-714.
	WANG J. Progress in clinical application of endoscopic thyroidectomy[J]. J Laparoscopic Surg, 2021, 26(9):711-714.
[13]	胡朝, 陈路阳, 叶志鹏, 等. 免充气腋窝入路手术治疗甲状腺乳头状癌对甲状旁腺功能的影响[J]. 中华普通外科杂志, 2022, 37(1):53-54.
	HU Z, CHEN L Y, YE Z P. Effect of non-pneumatic axillary approach on parathyroid function in the treatment of papillary thyroid carcinoma[J]. Chin J Gene Surg, 2022, 37(1):53-54.
[14]	JIANG W J, YAN P J, ZHAO C L, et al. Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis[J]. Surg Endosc, 2020, 34(5):1891-1903. doi: 10.1007/s00464-019-07283-y
[15]	黄能为, 易茂林, 单华静, 等. 免充气经腋窝入路全腔镜下甲状腺手术对喉返神经功能的影响[J]. 实用医学杂志, 2021, 37(13):1727-1731.
	HUANG N W, YI M L, SHAN H J, et al. Impact of total endoscopic thyroid surgery via air-free transaxillary approach on function of recurrent laryngeal nerve[J]. J Pract Med, 2021, 37(13):1727-1731.
[16]	中国临床肿瘤学会指南工作委员会. 中国临床肿瘤学会(CSCO)分化型甲状腺癌诊疗指南2021[J]. 肿瘤预防与治疗, 2021, 34(12):1164-1201.
	Guidelines Working Committee of Chinese Society of Clinical Oncology. Guidelines of Chinese Society of Clinical Oncology (CSCO) differentiated thyroid cancer[J]. J Cancer Control Treat, 2021, 34(12):1164-1201.
[17]	CANU G L, MEDAS F, CONZO G, et al. Is prophylactic central neck dissection justified in patients with cN0 differentiated thyroid carcinoma? An overview of the most recent literature and latest guidelines[J]. Ann Ital Chir, 2020, 91:451-457. pmid: 33295306

Item	Laparoscopic group (n=96)	Open group (n=232)	t/χ² value	P value
Surgical time （min）	168±23	95±18	4.16	0.022
Recognize recurrent laryngeal nerve (No)	96（100.0）	230（99.1）	2.41	0.138
Recognize superior parathyroid (No)	94（98.0)	225（97.0 ）	12.42	0.003
Recognize inferior parathyroid (No)	92（95.8）	230（99.1）	4.44	0.028
Drain amount in first postoperative day (mL)	42±22	25±10	5.06	0.006
Postoperative day in hospital (d)	2.8±0.6	1.8±1.2	3.85	0.016
Cost in hospital (Yuan)	13 186±1 015	12 632±1 456	1.23	0.365
Complication (No)	10(10.4)	21(9.1)	2.78	0.126