摘要
目的探讨腔镜手术在甲状腺微小乳头状癌治疗中的可行性和疗效。方法收集重庆医科大学附属第二医院乳腺甲状腺外科2015年4月至2017年12月收治的92例病理确诊为甲状腺微小乳头状癌的患者资料,按手术方式分为腔镜组和开放组,各46例,对比分析2组患者的临床病理指标及术后并发症。结果腔镜组和开放组患者在性别、年龄、美国麻醉医师协会(ASA)分级、肿瘤最大径、淋巴结清扫数目、并发症发生率等方面比较,差异均无统计学意义(P>0.05);腔镜组较开放组手术时间和住院时间延长,但切口较开放组小,差异均有统计学意义(P<0.05)。结论腔镜手术治疗甲状腺微小乳头状癌是安全、可行的,与开放手术疗效相当,且切口小、美观,可作为安全、有效的手术方案供患者选择。
Objective To investigate the feasibility and efficacy of endoscopic thyroidectomy for papillary thyroid microcarcinoma.Methods According to the types of operation,92 patients of papillary thyroid microcarcinoma diagnosed pathologically in the Second Hospital Affiliated of Chongqing Medical Universityfrom April 2015 and December 2017 were divided into the endoscopic group and the open group,46 cases each.The clinicopathological features and postoperative complication of the two groups were analyzed and compared.Results There were no statistical differences in the gender,age,ASA grade,maximum diameter of the tumor,number of lymph node dissections,and incidence of complications in the endoscopic group and the open group (P>0.05).Compared with the open group,the endoscopic group had longer operation time and length of hospital stay,but smaller incision,the differences were statistically significant (P<0.05).Conclusion Endoscopic surgery is safe and feasible for the treatment of papillary thyroid microcarcinoma,with similar curative effects,smaller incision and better cosmetic result to open surgery.It can be used as a safe and effective surgical treatment for patients to choose.
引文
[1]RUGGIERO R,BOSCO A,PIROZZI R,et al.Papillary thyroid microcarcinoma in super obese patient[J].G Chir,2018,39(3):173-176.
[2]LI F,CHEN G,SHENG C,et al.BRAFV600Emutation in papillary thyroid microcarcinoma:a meta-analysis[J].Endocr Relat Cancer,2015,22(2):159-168.
[3]中国抗癌协会甲状腺癌专业委员会(CATO).甲状腺微小乳头状癌诊断与治疗中国专家共识(2016版)[J].中国肿瘤临床,2016,43(10):405-411.
[4]李小毅.2015年美国甲状腺学会《成人甲状腺结节与分化型甲状腺癌诊治指南》解读:外科部分[J].中国癌症杂志,2016,26(1):13-18.
[5]林前煌,徐慧,郇金亮.甲状腺微小乳头状癌诊治进展[J].实用肿瘤学杂志,2017,31(1):61-64.
[6]殷德涛,许建辉.甲状腺癌基础研究的几个热点问题[J].中华医学杂志,2015,95(12):885-887.
[7]KIM HY,PARK WY,LEE KE,et al.Comparative analysis of gene expression profiles of papillary thyroid microcarcinoma and papillary thyroid carcinoma[J].J Cancer Res Ther,2010,6(4):452-457.
[8]MIYAUCHI A,ITO Y,ODA H.Insights into the management of papillary microcarcinoma of the thyroid[J].Thyroid,2018,28(1):23-31.
[9]ITO Y,MIYAUCHI A,ODA H.Low-risk papillary microcarcinoma of the thyroid:a review of active surveillance trials[J].Eur JSurg Oncol,2018,44(3):307-315.
[10]石臣磊,郭勇,吕一辰,等.适合手术的甲状腺微小乳头状癌患者临床病理特征[J].中华肿瘤杂志,2017,39(5):361-366.
[11]CHEN C,CHEN HZ,LYU CH,et al.Clinicopathological features of thyroid papillary microcarcinoma of which the maximum diameter is less than 5mm:a series of 487cases[J].Zhonghua Wai Ke Za Zhi,2016,54(11):870-874.
[12]贺建业,贺晨宇.U型拉钩降低腔镜辅助甲状腺腺叶切除术的喉返神经牵拉损伤[J].中国微创外科杂志,2016,16(12):1100-1102.
[13]柳学文,李强,陈飞,等.3D腔镜在甲状腺全切及中央区淋巴结清扫术中的临床效果[J].南方医科大学学报,2017,37(6):842-846.
[14]HUANG JK,MA L,SONG WH,et al.Quality of life and cosmetic result of single-port access endoscopic thyroidectomy via axillary approach in patients with papillary thyroid carcinoma[J].Onco Targets Ther,2016,9:4053-4059.
[15]Lee MC,Park H,Lee BC,et al.Comparison of quality of life between open and endoscopic thyroidectomy for papillary thyroid cancer[J].Head Neck,2016,38Suppl 1:E827-831.
