腔镜下经口腔前庭与全乳晕入路甲状腺手术的倾向得分匹配分析

Propensity score-matched analysis of endoscopic thyroidectomy via oral vestibule versus total areola approach

摘要:

目的 比较经口腔前庭入路与全乳晕入路腔镜甲状腺手术的短期临床结局，初步探讨经口腔前庭入路甲状腺手术的安全性。方法 收集2018年3月－2020年3月于南方医科大学附属中山市博爱医院接受经口腔前庭（n = 50）和全乳晕入路（n = 101）腔镜甲状腺手术患者的临床资料，经1∶1倾向评分匹配后，得到50对匹配的配对，比较两组患者临床结局。结果 经口腔前庭组建腔时长［（39.9±10.0）和（32.7±7.2）min，P < 0.01］和手术时间［（194.3±32.4）和（159.3±33.7）min，P < 0.01］明显较经全乳晕入路组长，首日引流量明显较经全乳晕入路组少［（50.8±22.7）和（64.8±34.8）mL，P = 0.019］，总费用较经乳晕入路组高［（23 626.5±5 217.6）和（17 879.7±3 534.7）元，P < 0.05］。两组患者术中出血量、总引流量、引流管留置时长、术后住院时长和术后并发症发生情况比较，差异均无统计学意义（P > 0.05）。结论 尽管经口腔前庭入路的甲状腺手术时间较经全乳晕入路长，且费用更高，但在手术并发症及住院时长方面并无明显差异。对美容有特殊要求的患者来说，经口腔前庭入路甲状腺手术是一种安全的选择。

Abstract:

Objective To compare the short-term clinical outcomes of thyroid surgery via oral vestibular approach and the total areola approach, preliminary explore the safety of thyroid surgery via oral vestibular approach.Methods Clinical data of patients receiving endoscopic thyroid surgery via the oral vestibule (n = 50) and the total areola approach (n = 101) from 2018 March to 2020 March were collected. After the 1∶1 propensity score matching, 50 matched pairs were obtained. Then the surgical outcomes between the two groups were compared.Results Compared with the patients in the areola approach group, the cavity-building time [(39.9 ± 10.0) and (32.7 ± 7.2) min, P < 0.01] and operation time [(194.3 ± 32.4) and (159.3 ± 33.7) min, P < 0.01] in the oral vestibular approach group were significant longer, the drainage volume on the postoperative day 1 decreased significantly [(50.8 ± 22.7) and (64.8 ± 34.8) mL, P = 0.019], and the total cost was higher [(23 626.5 ± 5 217.6) and (17 879.7 ± 3 534.7) yuan, P < 0.05]. There were no significant differences between the two groups in terms of intraoperative blood loss, total drainage volume, drainage period, postoperative hospital stay, and postoperative complications.Conclusion Compared with the areola approach, although the thyroid surgery via the oral vestibular approach is slightly longer and more expensive, there is no significant difference in surgical complications and length of hospitalization. For patients with cosmetic requirements, thyroid surgery via the oral vestibular approach is a safe option.