[1]李景铧,张帆,张毅,等.全腔镜与开放手术治疗cT1N0甲状腺乳头状癌的临床对比研究[J].第三军医大学学报,2019,41(15):1461-1467.
 LI Jinghua,ZHANG Fan,ZHANG Yi,et al.Clinical comparison of total endoscopy and open thyroidectomy for cT1N0 thyroid papillary carcinoma[J].J Third Mil Med Univ,2019,41(15):1461-1467.
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全腔镜与开放手术治疗cT1N0甲状腺乳头状癌的临床对比研究(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第15期
页码:
1461-1467
栏目:
临床医学
出版日期:
2019-08-15

文章信息/Info

Title:
Clinical comparison of total endoscopy and open thyroidectomy for cT1N0 thyroid papillary carcinoma
作者:
李景铧张帆张毅苑龙姜军
陆军军医大学(第三军医大学)第一附属医院乳腺甲状腺外科
Author(s):
LI Jinghua ZHANG Fan ZHANG Yi YUAN Long JIANG Jun

Department of Breast and Thyroid Surgery, First Affiliated Hospital, Army Military Medical University (Third Military Medical University), Chongqing, 400038, China

关键词:
甲状腺乳头状癌腔镜甲状腺手术
Keywords:
thyroid papillary carcinoma endoscopic thyroidectomy
分类号:
R619; R653; R736.1
文献标志码:
A
摘要:

目的 探讨胸乳入路全腔镜(totally endoscopic thyroidectomy,TET)在cT1N0甲状腺乳头状癌外科治疗中的可行性。方法 回顾性分析2016年3月至2018年6月在陆军军医大学(第三军医大学)西南医院乳腺甲状腺外科完成的287例原发性cT1N0甲状腺乳头状癌患者临床资料,其中行全腔镜手术治疗(腔镜组)145例,行开放治疗(开放组)142例。对比分析两组患者术中情况、并发症、复发及美容效果。结果 腔镜组与开放组患者一般资料如平均年龄(P=0.283)、性别比例(P=0.344)、肿瘤大小(P=0.265)及病灶分布情况(P=0.872)具有可比性。手术效果方面,针对一侧腺叶切除+一侧中央区清扫患者,腔镜组与开放组中央区淋巴结清扫数目(P=0.847)、转移淋巴结数目(P=0.839)方面无显著差异。腔镜组术中出血量显著少于开放组(P<0.001),而手术时间显著长于开放组(P<0.001)。针对双侧腺叶切除+一侧中央区清扫患者,腔镜组与开放组中央区淋巴结清扫数目(P=0.092)、转移淋巴结数目(P=0.241)方面无显著差异。腔镜组术中出血量显著少于开放组(P<0.001),手术时间显著长于开放组P<0.001)。手术并发症方面,两组患者术后并发症暂时性/永久性甲状旁腺功能减退及喉返神经损伤方面无显著差异(P>0.05)。腔镜组患者术后无1例出血皮下积液及创面感染。在美容效果方面,腔镜组显著优于开放组(P<0.01)。两组患者随访时间为 (6~30) 个月,无1例患者复发。结论 TET治疗cT1N0甲状腺乳头状癌是安全可行的,TET可作为有美容需求cT1N0甲状腺乳头状癌者的优选手术方式。

Abstract:

Objective To explore the feasibility of totally endoscopic thyroidectomy (TET) for thyroid papillary carcinoma in cT1N0 stage. MethodsClinical data of 287 patients with primary cT1N0 thyroid papillary cancer underwent thyroidectomy in our hospital from March 2016 to June 2018 were collected and retrospectively analyzed, including 145 patients undergoing TET (TET group) and 142 patients by open thyroidectomy (OT group). The intraoperative conditions, complications, recurrence and cosmetic effect were compared between the 2 groups. ResultsThere were no significant differences in the general data of the patients in the TET group and OT group, including mean age (P=0.283), sex ratio (P=0.344), tumor size (P=0.265) and tumor distribution (P=0.872). In terms of surgical effects, no significant differences were observed in the numbers of central neck lymph node dissections (CNLN) (P=0.847) and metastatic lymph nodes (P=0.839) between the 2 groups for the patients with lateral lobectomy and lateral central neck dissection. The TET group had significantly smaller volume of intraoperative bleeding (P<0.001), and longer operation time (P<0.001) when compared with the OT group. For those with bilateral lobectomy and lateral central neck dissection, there were no significant differences in the numbers of central neck lymph node dissections (P=0.092) and metastatic lymph nodes (P=0.241) between the 2 groups. The amount of intraoperative bleeding was smaller (P<0.001) and the operation time were longer in the TET group (P<0.001) than the OT group. For surgical complications, there were no significant differences in the incidences of temporary/permanent hyperparathyroidism and recurrent laryngeal nerve injury between the 2 group (P>0.05). No hemorrhagic subcutaneous fluid or wound infection occurred in the TET group. The TET group had significantly better cosmetic effect than the OT group (P<0.001). The patients were followed up for 6 to 30 months, and no recurrence was observed. ConclusionTET treatment is safe and feasible for cT1N0 thyroid papillary cancer. TET treatment might be an optional approach for the patients with cosmetic demand.

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更新日期/Last Update: 2019-08-13