目的

探析甲状腺癌患者腔镜下不同入路行甲状腺癌根治术的效果。

方法

回顾性分析2021年1月至2023年12月接受腔镜下甲状腺癌根治术的115例患者资料，将57例经全乳晕入路患者纳入全乳晕组，58例经免充气腋窝入路患者纳入腋窝组。所有数据采用SPSS 25.0统计软件分析处理，偏态分布的计量资料以［M(P₂₅, P₇₅)］描述，不同组别的资料采用Mann-Whitney U检验，正态分布的计量资料以（）表示，组间采用独立样本t检验，组内采用配对样本t检验；计数资料以［例（%）］表示，采用χ²检验，等级资料采用秩和检验。以P<0.05表示差异有统计学意义。

结果

两组淋巴结清扫量比较，差异无统计学意义（P>0.05）；腋窝组手术时间短于全乳晕组，术后引流量少于全乳晕组（P<0.05）。术后3d，腋窝组患者血钙、甲状旁腺素（PTH）水平高于全乳晕组，血清肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）水平低于全乳晕组（P<0.05）。腋窝组患者数字评定量表（NRS）和Vancouver瘢痕评定量表（VSS）评分均低于对照组（P<0.05）。腋窝组患者术后并发症总发生率低于全乳晕组（P<0.05），组间复发率比较差异无统计学意义（P>0.05）。

结论

相较全乳晕入路，免充气腋窝入路下甲状腺癌根治术手术时间短、术后引流量少，对甲状旁腺功能造成的刺激轻微，术后美观度更佳，且能减少并发症发生。

Objective

To explore the effects of different approaches in endoscopic radical resection of thyroid cancer for patients with thyroid cancer.

Methods

The data of 115 patients who underwent endoscopic radical resection of thyroid cancer from January 2021 to December 2023 were retrospectively analyzed. 57 patients with the total areola approach were included in the total areola group, and 58 patients with the gasless axillary approach were included in the axillary group. All data were analyzed and processed using the SPSS 25.0 statistical software. Measurement data with a skewed distribution were described as［M(P₂₅, P₇₅)］, and the Mann-Whitney U test was used for data of different groups. Measurement data with a normal distribution were expressed as (), an independent sample t test was used between groups, and a paired sample t test was used within groups; Enumeration data were expressed as［ cases (%)］, and the χ² test was used, and the Rank Sum test was used for ranked data. P<0.05 was considered to indicate a statistically significant difference.

Results

There was no statistically significant difference in the number of lymph node dissections between the two groups (P>0.05); The operation time in the axillary group was shorter than that in the total areola group, and the postoperative drainage volume was less than that in the total areola group (P<0.05).Three days after the operation, the levels of blood calcium and parathyroid hormone (PTH) in the patients of the axillary group were higher than those in the total areola group, and the levels of serum tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6) were lower than those in the total areola group (P<0.05). The scores of the Numerical Rating Scale (NRS) and the Vancouver Scar Scale (VSS) of the patients in the axillary group were lower than those in the control group (P<0.05). The incidence of postoperative complications in the axillary group was lower than that in the total areola group (P<0.05), and there was no statistically significant difference in the recurrence rate between the groups (P>0.05).

Conclusion

Compared with the total areola approach,the gasless axillary approach in endoscopic radical resection of thyroid cancer has a shorter operation time and less postoperative drainage volume, causes mild stimulation to the function of the parathyroid gland, has better postoperative aesthetic appearance, and can reduce the occurrence of complications.