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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (03) : 331 -334. doi: 10.3877/cma.j.issn.1674-3946.2021.03.026

所属专题： 文献；

论著

改良Miccoli术式与完全腔镜术式治疗甲状腺微小乳头状癌的临床效果对比研究
李俊强1, 邱春丽2, 李宏1, 宫小勇1, 周智辉1, 李媛媛1, 代引海1,†()   
  1. 1. 712000　陕西中医药大学第二附属医院肿瘤乳腺外科
    2. 712000　陕西中医药大学第二附属医院肿瘤介入科
  • 收稿日期:2020-04-21 出版日期:2021-06-26
  • 通信作者: 代引海

A comparative study on the clinical effect of modified Miccoli surgery and complete endoscopic surgery in the treatment of thyroid micro papillary carcinoma

Junqiang Li1, Chunli Qiu2, Hong Li1, Xiaoyong Gong1, Zhihui Zhou1, Yuanyuan Li1, Yinhai Dai1,†()   

  1. 1. Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shanxi Province, 712000; Cancer Breast Surgery
    2. Oncology Interventional Branch
  • Received:2020-04-21 Published:2021-06-26
  • Corresponding author: Yinhai Dai
  • Supported by:
    Shaanxi University of traditional Chinese Medicine discipline innovation team project(2019-YS03); Special scientific research program of shaanxi education department(17JK0209)
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李俊强, 邱春丽, 李宏, 宫小勇, 周智辉, 李媛媛, 代引海. 改良Miccoli术式与完全腔镜术式治疗甲状腺微小乳头状癌的临床效果对比研究[J]. 中华普外科手术学杂志(电子版), 2021, 15(03): 331-334.

Junqiang Li, Chunli Qiu, Hong Li, Xiaoyong Gong, Zhihui Zhou, Yuanyuan Li, Yinhai Dai. A comparative study on the clinical effect of modified Miccoli surgery and complete endoscopic surgery in the treatment of thyroid micro papillary carcinoma[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(03): 331-334.

目的

比较改良Miccoli术式与完全腔镜术式治疗甲状腺微小乳头状癌(PTMC)的临床效果。

方法

选择2016年7月至2019年8月140例PTMC手术治疗患者，经伦理委员会批准通过，按照患者意愿分为改良组(n＝70)和腔镜组(n＝70)。腔镜组患者给与完全腔镜术治疗方案，改良组患者给与改良Miccoli术治疗方案。数据采用SPSS23.0进行统计分析，术前和术后血钙、甲状腺球蛋白抗体(TgAb)和甲状旁腺素(PTH)水平用(±s)表示，独立t检验；术后并发症采用χ2检验，P<0.05表示差异有统计学意义。

结果

改良组住院时间、手术时间、术中出血量以及术后引流量均明显低于腔镜组，差异有统计学意义(P<0.05)；两组术后清扫淋巴结数和转移淋巴结数差异无统计学意义(P>0.05)。术后3 d，改良组血钙、PTH水平显著高于腔镜组(P<0.05)，TgAb水平两组差异无统计学意义(P>0.05)。改良组术后并发症发生率(5.7%)显著低于腔镜组(24.3%)，差异有统计学意义(P<0.05)。

结论

改良Miccoli术治疗PTMC患者效果优于完全腔镜术，可明显改善患者PTH水平，降低并发症的发生。

关键词: 甲状腺肿瘤, 腺癌, 乳头状, 腹腔镜, 改良Miccoli术, 疗效比较研究
Objective

To compare the clinical effects of modified Miccoli and complete endoscopic treatment for papillary thyroid micropapillary carcinoma (PTMC).

Methods

A total of 140 patients undergoing PTMC surgery from July 2016 to August 2019 were selected and approved by the ethics committee. According to the patients’ wishes, they were divided into the improved group (n=70) and endoscopic group (n=70). Patients in the endoscopic group received complete endoscopic surgery, and patients in the improved group received modified Miccoli surgery. SPSS23.0 was used for statistical analysis. Preoperative and postoperative serum calcium, thyroglobulin antibody (TgAb) and thyroxine (PTH) were analyzed by (±s), and independent t test was performed. Chi-square test was used for postoperative complications, and P<0.05 indicated a statistically significant difference.

Results

The number of metastatic lymph nodes, length of hospital stay, operation time and intraoperative blood loss in the improved group were significantly lower than those in the endoscopic group, while the number of dissected lymph nodes and postoperative drainage volume were significantly higher than those in the endoscopic group, with statistical significance (P<0.05). On day 3 after operation, the serum calcium and PTH levels in the modified group were significantly higher than those in the endoscopic group (P<0.05), but there was no significant difference in TgAb levels between the two groups (P>0.05). The incidence of postoperative complications in the improved group (5.7%) was significantly lower than that in the endoscopic group (24.3%), and the difference was statistically significant (P<0.05).

Conclusion

The effect of modified Miccoli is better than that of complete endoscopy, which can significantly improve the level of PTH and reduce the occurrence of complications.

Key words: Thyroid neoplasms, Adenocarcinoma, papillary, Laparoscopes, Modified miccoli surgery, Comparative effectiveness research
表1 140例PTMC患者不同术式两组患者一般资料比较[(±s)，例]
组别 例数 BMI(kg/m2) 年龄(岁) 性别 肿瘤情况
男/女 单灶/多灶
改良组 70 23.4±5.7 47.3±8.2 18/52 55/15
腔镜组 70 22.4±5.8 48.2±7.3 20/50 52/18
t/χ2   0.478 0.498 3.785 4.142
P值   0.615 0.579 0.288 0.076
组别 例数 TNM分期 病理类型
Ⅰ/Ⅱ/Ⅲ 腺癌/粘液腺癌/未分化癌/其它
改良组 70 28/32/10 20/23/24/3
腔镜组 70 31/30/9 18/24/26/2
t/χ2   0.128 0.328
P值   0.743 0.632
表2 140例PTMC患者不同术式两组患者术中术后指标比较(±s)
组别 例数 清扫淋巴结数 转移淋巴结数 住院时间(d)
改良组 70 23.1±3.2 3.3±1.1 4.5±1.6
腔镜组 70 23.2±3.0 3.5±1.1 5.9±1.5
t值   0.152 0.143 2.945
P值   >0.05 >0.05 <0.01
组别 例数 手术时间(min) 术中出血量(ml) 术后引流量(ml)
改良组 70 72.2±11.3 15.3±4.0 45.7±21.1
腔镜组 70 143.6±28.2 37.6±5.4 116.8±35.3
t值   12.883 17.243 15.817
P值   <0.001 <0.001 <0.001
表3 140例PTMC患者不同术式两组患者术前术后血钙、TgAb和PTH水平比较(±s)
组别 例数 时间 血钙(mmol/l) TgAb(ng/ml) PTH(pg/ml)
改良组 70 术前 2.22±0.31 68. 5±12.4 46.3±6.1
    术后 2.04±0.26a 54.3±10.6 35.5±5.4a
腔镜组 70 术前 2.30±0.25 69.1±12.8 45.9±6.6
    术后 1.68±0.30 53.4±11.2 27.6±4.9
表4 140例PTMC患者不同术式两组患者术后并发症水平比较(例)
组别 例数 喉返神经损坏 甲状旁腺功能减退 副神经损伤暂 低血钙症 总发生率(%)
暂时性/永久性 暂时性/永久性 时性/永久性 暂时性/永久性
改良组 70 1/0 2/0 0/0 1/0 4(5.7)
腔镜组 70 2/1 4/1 2/0 5/2 17(24.3)
χ2           6.775
P值           <0.01
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