腔镜辅助与中转开放在甲状腺微小乳头 状癌手术疗效的对比研究

Efficacy comparative study of video-assisted thyroidectomy with intraoperative conversion to open thyroidectomy for papillary thyroid microcarcinoma

摘要:

目的 回顾对比分析腔镜辅助与中转开放甲状腺微小乳头状癌手术的临床效果。 方法 2009年4月～2012年6月接受腔镜辅助甲状腺手术且术中确诊为甲状腺微小乳头状癌的患者，根据继续腔镜手术或中转开放手术分为腔镜辅助组（32例）和中转组（20例），手术范围为患侧甲状腺腺叶切除+对侧腺叶次全切除（或全切术）+VI区清扫术。比较两组术式的临床治疗效果。 结果 两组手术出血量、术后引流量、中央区淋巴结清扫数量、术后住院时间和手术并发症发生率差异均无显著性（P >0.05）。腔镜辅助组术后3个月美容效果评分显著高于中转组（t =30.243，P =0.000）。腔镜辅助组手术时间长于中转开放组（108±19.7）vs（89.7±11.6）min，P = 0.014；腔镜组低钙血症2例及中转组低钙血症1例，均于出院前缓解。腔镜组3例暂时性喉返神经麻痹于术后，4至6周恢复。两组分别随访（21±8.6）和（24.8±10.1）个月，均未见肿瘤复发和转移。 结论 腔镜辅助下甲状腺手术治疗PTMC是安全、有效的，有更加令人满意的美容效果，可作为PTMC手术治疗的一种选择。

Abstract:

Abstract: 【Objective】 To compare the clinical efficacy of video-assisted thyroidectomy and intraoperative conversion to open thyroidectomy in patients with papillary thyroid microcarcinoma (PTMC). 【Methods】 Between April 2009 and June 2012, 52 patients, who underwent video-assisted thyroidectomy in our hospital for papillary thyroid microcarcinoma, were included in this study.In the patients, video-assisted thyroidectomy was completed in 32 cases(endoscopy group). And the other 20 were converted to open surgery during the endoscopy (conversion group). Both the groups received lobotomy plus central compartment dissection and contralateral subtotal (total) lobotomy. 【Results】 No significant difference was detected in the postoperative drainage volume, intraoperative blood loss, number of resected lymph nodes, and postoperative hospital stay.Cosmetic result of wound evaluated by numeric scale was in favor of group endoscopy(t =30.243, P =0.000). The endoscopy group showed significantly of operation time longer than the conversion group (108.0±19.7) vs (89.7±11.6) min, P =0.014. In the endoscopy group, 2 patients showed hypocalcemia, while in the conversion group, 1 patient developed hypocalcemia, all of them wererelieved before being discharged.In the endoscopy group 3 patients developed transient recurrent laryngeal nerve paralysis, and were cured spontaneously in 4-6 weeks. There was no metastasis or recurrence in the both groups during follow-up[(21±8.6) months VS (24.8±10.1) months]. 【Conclusion】 Video-assisted thyroidectomy is safe and effective,the former gives better cosmetic outcomes. It is a choice of the surgical treatment for selected case of PTMC.