不同手术方法治疗甲状腺良性疾病对甲状旁腺功能和美观度的影响

Impact of different surgical methods for treating benign thyroid diseases on parathyroid function and aesthetic appearance

摘要:

目的 探讨甲状腺良性疾病患者应用经全乳晕入路腔镜下甲状腺手术和经颈部入路甲状腺良性病变手术治疗的效果。方法 回顾性分析2021年11月－2024年2月该院86例甲状腺良性疾病患者的临床资料，根据不同手术方法，将患者分为A组和B组，各43例。A组接受经颈部入路甲状腺良性病变手术，B组接受经全乳晕入路腔镜下甲状腺手术，两组患者术后均随访1年。比较两组患者围手术期相关指标，术前和术后1个月的甲状旁腺功能，术前和术后1年的吞咽功能、颈部疼痛程度和美观度，术后1年内的并发症发生情况。结果 B组术中出血量少于A组，住院时间短于A组，住院费用高于A组，差异均有统计学意义（P < 0.05）。两组患者术后1个月的血钙和甲状旁腺激素（PTH）水平较术前低，但B组高于A组，差异均有统计学意义（P < 0.05）。两组患者术后1年的吞咽功能评估量表（SSA）评分、颈部疼痛视觉模拟评分法（VAS）评分、患者瘢痕自我评分（PSAS）、温哥华瘢痕评价量表（VSS）和观测者瘢痕评价量表（OSAS）评分较术前低，且B组低于A组，差异均有统计学意义（P < 0.05）。术后1年内，A组并发症总发生率为20.93%，高于B组的4.65%，差异有统计学意义（P < 0.05）。结论 经全乳晕入路腔镜下甲状腺手术较经颈部入路甲状腺良性病变手术，可改善甲状旁腺和吞咽功能，减少甲状腺良性疾病患者术中出血量，缩短住院时间，减轻颈部疼痛程度，提高美观度，且安全性好，但该手术住院费用较高，临床需结合患者具体情况，合理地选择手术方案。

Abstract:

Objective To explore the therapeutic effects of endoscopic thyroid surgery via the total areola approach and surgery for benign thyroid lesions via the cervical approach in patients with benign thyroid diseases.Methods A retrospective analysis was conducted on the clinical data of 86 patients with benign thyroid diseases from November 2021 to February 2024. The patients were divided into group A and group B according to different surgical methods, with 43 cases in each group. Group A underwent surgery for benign thyroid lesions via the cervical approach, while group B received endoscopic thyroid surgery via the total areola approach. Both groups of patients were followed up for one year after the operation. The perioperative related indicators, parathyroid function before and one month after operation, swallowing function, neck pain and aesthetics before and one year after operation, and complications within one year after operation were compared between the two groups.Results The intraoperative blood loss in group B was less than that in group A, the hospital stay was shorter than that in group A, and the hospitalization cost was higher than that in group A. The differences were all statistically significant (P < 0.05). The levels of blood calcium and parathyroid hormone (PTH) in both groups of patients one month after the operation were lower than those before the operation, but those in group B were higher than those in group A, the differences were statistically significant (P < 0.05). One year after the operation, the standard swallowing function assessment scale (SSA), neck pain visual analogue scale (VAS), patient scar assessment scale (PSAS), Vancouver scar scale (VSS), and observer scar assessment scale (OSAS) score of the two groups of patients were lower than those before the operation, and those in group B were lower than those in group A, the differences were statistically significant (P < 0.05). Within one year after the operation, the total incidence of complications in group A was 20.93%, which was higher than 4.65% in group B, and the difference was statistically significant (P < 0.05).Conclusion Compared with the cervical approach for benign thyroid lesion surgery, endoscopic thyroid surgery via the total areola approach can improve parathyroid gland and swallowing functions, reduce intraoperative blood loss in patients with benign thyroid diseases, shorten hospital stay, reduce the severity of neck pain, enhance aesthetic appearance, and has good safety. However, the hospitalization cost of this surgery is relatively high. Clinically, the surgical plan should be reasonably selected based on the specific conditions of the patient.