经口腔前庭及经乳晕入路腔镜甲状腺切除术治疗甲状腺结节的疗效对比

Curative effect of endoscopic thyroidectomy through oral vestibule and areola approaches in treatment of thyroid nodules: a comparative study

摘要:

目的 探究经口腔前庭与经乳晕入路腔镜甲状腺切除术治疗甲状腺结节患者的临床效果及安全性。方法 选择该院收治的69例甲状腺结节患者，以2017年2月－2020年6月在该院接受经乳晕入路腔镜甲状腺切除术的33例作为经乳晕组，以同期接受经口腔前庭腔镜甲状腺切除术治疗的36例作为经口腔组。比较两组患者手术指标［手术时间、术中出血量、术前术后疼痛视觉模拟评分（VAS）、术后住院时间、术后引流量］，采用嗓音障碍指数（VHI）、吞咽障碍评分量表（SIS）评估手术前后两组患者嗓音和吞咽功能变化，手术前后采用90项症状自评量表（SCL-90）评估两组患者心理状况，生活质量调查问卷（EORTC QLQ-C30）评估两组患者生活质量，并比较两组患者并发症发生率。结果 经口腔组手术时间较经乳晕组长，术中出血量、术后引流量、瘢痕长度明显少于经乳晕组（P < 0.05），术后两组患者VAS评分较术前均明显升高（P < 0.05），但术后经口腔组VAS评分较经乳晕组低（P < 0.05）。与同组术前比较，术后两组患者VHI评分、SIS评分明显降低（P < 0.05），但术后两组患者VHI评分、SIS评分比较，差异无统计学意义（P > 0.05）。与术前比较，术后两组患者SCL-90评分明显降低，且经口腔组明显低于经乳晕组，两组患者术后EORTC QLQ-C30评分明显增高，且经口腔组明显高于经乳晕组（P < 0.05）。经口腔组并发症发生率较经乳晕组略低，且两组患者中双侧切除者并发症发生率略高于单侧切除者，但差异无统计学意义（P > 0.05）。结论 与经乳晕入路腔镜甲状腺切除术相比，经口腔前庭入路腔镜甲状腺切除术治疗甲状腺结节的组织损伤小、术后疼痛轻、无瘢痕，更利于维持患者术后心理健康和良好的生活质量，且后者手术安全性更高。

Abstract:

Objective To explore the clinical effects and safety of endoscopic thyroidectomy through oral vestibule and areola approaches in treatment of patients with thyroid nodules.Methods 69 patients with thyroid nodules were enrolled in this study. Among them, 33 patients who underwent endoscopic thyroidectomy through areola approach between February 2017 and June 2020 were included in the areola approach group, and 36 patients who underwent endoscopic thyroidectomy through oral vestibule approach were included in the transoral group. The surgical indexes [operation time, intraoperative blood loss, scores of visual analogue scale (VAS) before and after surgery, postoperative hospitalization time, postoperative drainage volume] were compared between the two groups. The changes of voice and swallowing function in both groups before and after surgery were assessed by voice handicap index (VHI) and swallowing impairment score (SIS). The psychological status in both groups before and after surgery was evaluated by symptom checking list-90 (SCL-90). The quality of life in both groups was evaluated by European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30). The incidence of complications was compared between the two groups.Results The operation time of the transoral group was significantly longer than that of the areola approach group. The intraoperative blood loss, postoperative drainage volume and scar length were significantly less or smaller than those of the areola approach group (P < 0.05). After surgery, VAS scores of the two groups were significantly increased (P < 0.05), and the scores of the transoral group were significantly lower than those of the areola approach group (P < 0.05). After surgery, VHI and SIS scores of the two groups were significantly decreased (P < 0.05), without significant differences between the two groups (P > 0.05). After surgery, SCL-90 scores of the two groups were significantly decreased, and the scores of the transoral group were significantly lower than those of the areola approach group. The EORTC QLQ-C30 scores of the two groups were significantly increased, and the scores of the transoral group were significantly higher than those of the areola approach group (P < 0.05). The incidence of complications in the transoral group was slightly lower than that in the areola approach group. In the two groups, the incidence of complications in patients undergoing bilateral resection was slightly lower than that in patients undergoing unilateral resection (P > 0.05).Conclusion Compared with the areola approach, there was less tissue damage, milder postoperative pain and no scars in patients with thyroid nodules treated with endoscopic thyroidectomy through oral vestibule approach, which is more conducive to maintaining postoperative health psychology status and good quality of life, with higher surgical safety.