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J Zhejiang Univ (Med Sci)  2021, Vol. 50 Issue (6): 716-721    DOI: 10.3724/zdxbyxb-2021-0291
    
Endoscopic thyroidectomy using gasless axillary approach for low-risk papillary thyroid carcinoma
XU Shiying1,WANG Peien2,MIAO Beibei2,XU Tengfei2,ZHANG Yongqiang2,WANG Jiafeng3,CHEN Shan2,*()
1. The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, China;
2. Department of Head, Neck and Breast Surgery, Taizhou Cancer Hospital, Wenling 317502, Zhejiang Province, China;
3. Department of Head and Neck Surgery, Center of Otolaryngology, Head and Neck Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital of Hangzhou Medical College, Hangzhou 310014, China
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Abstract  

Objective: To evaluate the application of endoscopic thyroidectomy using gasless axillary approach (ET-GA) for low-risk papillary thyroid carcinoma (PTC). Methods: Patients with T1N0M0 Ⅰ PTC undergoing unilateral thyroid lobectomy with central neck dissection in Taizhou Cancer Hospital during January 2019 to June 2021 were enrolled in the study, including 35 cases treated with ET-GA (ET-GA group) and 35 cases treated with conventional open thyroidectomy (COT group). The surgical treatment effect, cosmetic effect and the effect on neck function were compared between two groups. Neck function was evaluated by neck pain score, neck injury index and dysphagia index. Cosmetic effect was evaluated by cosmetic effect satisfaction score. Results: In the ET-GA group, all unilateral thyroid lobectomy with central neck dissection were successfully completed, and no case was converted to open surgery. The number of central lymph nodes dissected in the ET-GA was not statistically different from that in the COT group (P>0.05), but the operation time was longer than that of the COT group (P<0.01). In the ET-GA group, 2 cases (5.7%) had transient vocal cord paralysis and 1 case (2.9%) had postoperative bleeding. In the COT group, 1 case (2.9%) had transient vocal cord paralysis, no postoperative bleeding. There was no significant difference in the complication rate between two groups (P>0.05). At 3?d and 3?months postoperatively, there was no significant difference in neck pain score and neck injury index between two groups (bothP>0.05); dysphagia index was lower in ET-GA group, but the difference was not statistically significant (P>0.05). The cosmetic effect satisfaction score of ET-GA group was higher than that in the COT group at 3?months postoperatively (4.3±0.6 vs.3.2±1.0,P<0.01).Conclusion: ET-GA has the same efficacy and safety as conventional open thyroidectomy in the treatment of low-risk PTC, and it improves the satisfaction of postoperative cosmetics.



Key wordsPapillary thyroid carcinoma      Axillary approach      Endoscopic thyroidectomy      Radical thyroid cancer surgery      Paired study     
Received: 22 September 2021      Published: 22 March 2022
CLC:  R736.1  
Corresponding Authors: CHEN Shan     E-mail: 13656790357@163.com
Cite this article:

XU Shiying,WANG Peien,MIAO Beibei,XU Tengfei,ZHANG Yongqiang,WANG Jiafeng,CHEN Shan. Endoscopic thyroidectomy using gasless axillary approach for low-risk papillary thyroid carcinoma. J Zhejiang Univ (Med Sci), 2021, 50(6): 716-721.

URL:

https://www.zjujournals.com/med/10.3724/zdxbyxb-2021-0291     OR     https://www.zjujournals.com/med/Y2021/V50/I6/716


无充气腋窝入路完全腔镜手术在低危甲状腺乳头状癌患者中的应用研究

目的:探讨无充气腋窝入路完全腔镜下手术治疗低危甲状腺乳头状癌(PTC)的应用价值。方法:通过配对研究纳入台州市肿瘤医院头颈乳腺外科2019年1月至2021年6月实施无充气腋窝入路完全腔镜手术(腋窝腔镜组,n=35)和传统开放手术(开放手术组,n=35)治疗的PTC患者,所有患者的临床分期均为T1N0M0 Ⅰ期,手术方式均为患侧甲状腺腺叶及峡部切除+同侧颈部中央淋巴结(简称中央淋巴结)清扫术。比较两组的手术治疗效果、美容效果及对颈部功能的影响。颈部功能评价采用颈部疼痛评分、颈部损伤指数和吞咽障碍指数调查,美容效果评价采用美容效果满意度评分。结果:腋窝腔镜组全部顺利完成患侧甲状腺腺叶及峡部切除+同侧中央淋巴结清扫术,均无中转开放手术。腋窝腔镜组中央淋巴结清扫数与开放手术组差异无统计学意义(P>0.05),但手术时间较开放手术组延长(P<0.01)。腋窝腔镜组中,暂时性声带麻痹2例(5.7%),术后出血1例(2.9%);开放手术组中,暂时性声带麻痹1例(2.9%),均无术后出血。两组术后并发症发生率差异无统计学意义(P>0.05)腋窝腔镜组和开放手术组术后3?d和3个月的颈部疼痛评分和颈部损伤指数差异均无统计学意义(均P>0.05);腋窝腔镜组术后吞咽障碍指数低于开放手术组,但差异无统计学意义(P>0.05)。腋窝腔镜组和开放手术组术后3个月的美容效果满意度评分分别为(4.3±0.6)分和(3.2±1.0)分,差异有统计学意义(P<0.01)。结论:无充气腋窝入路完全腔镜下手术治疗低危PTC的手术疗效和安全性与开放手术相仿,但提高了患者术后美容满意度。


关键词: 甲状腺乳头状癌,  腋窝入路,  内镜甲状腺切除术,  甲状腺癌根治术,  配对研究 

组别

n

年龄(岁)

性别(男/女)

身体质量指数(kg/m2

转移性中央淋巴结(无/有)

肿瘤最大径(mm)

微小癌(否/是)

肿瘤多灶性(否/是)

癌灶部位(左侧/右侧)

腋窝腔镜组

35

37±9

6/29

24±3

27/8

7.1±3.4

4/31

31/4

19/16

开放手术组

35

39±8

6/29

23±3

25/10

7.4±2.9

4/31

28/7

18/17

F/χ2

1.295

0.901

0.299

0.416

0.971

0.057

P

>0.05

>0.05

>0.05

>0.05

>0.05

>0.05

Table1 Baseline data of patients with conventional open thyroidectomy and endoscopic thyroidectomy using gasless axillary approach
Figure1 Main steps of endoscopic thyroidectomy using gasless axillary approach

组别

n

颈部疼痛评分

颈部损伤指数

吞咽障碍指数

美容满意度评分

术后3?d

术后3个月

术后3?d

术后3个月

术后3?d

术后3个月

腋窝腔镜组

35

2(2,3)

1(0,1)

5(3,6)

2(1,4)

3(2,7)

2(0,3)

4.3±0.6

开放手术组

35

2(2,3)

1(0,1)

5(3,5)

2(1,3)

5(3,7)

2(1,3)

3.2±1.0

Z/F

0.092

0.253

1.059

1.165

1.769

1.041

5.302

P

>0.05

>0.05

>0.05

>0.05

>0.05

>0.05

<0.01

Table2 Comparison of postoperative neck function and cosmetic effect between conventional open thyroidectomy group and endoscopic thyroidectomy using gasless axillary approach group
Figure2 Surgical incision of endoscopic thyroidectomy using gasless axillary approach
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