标题：腔镜和开放式中央区淋巴结清扫术在甲状腺乳头状癌中的应用

      作者：罗振峰 1，杨航 2，李恒 2    石泉县医院耳鼻喉咽喉头颈外科 1、耳鼻喉科 2，陕西 安康 725200

      卷次： 2021年32卷3期

      【摘要】 目的 比较腔镜和开放式甲状腺乳头状癌切除术+中央淋巴结清扫术治疗甲状腺乳头状癌的疗效。方法 回顾性分析2015年1月至2017年1月期间石泉县医院收治的81例甲状腺乳头状癌患者的临床资料，其中38例行开放式手术者作为开放组，43例行腔镜手术者作为腔镜组，比较两组患者手术一般情况(切口长度、手术时间、术中出血量、中央区淋巴结清扫数目、拔管时间、引流量、术后住院时间)、术后不同时间视觉模拟评分(VAS)、手术前后炎症因子水平[白细胞计数(WBC)、C反应蛋白(CRP)、白介素-6 (IL-6)]、手术并发症发生率、术后3个月美容效果及随访3年的肿瘤复发率、转移率。结果 腔镜组患者切口长度为(2.23±1.18) cm，明显短于开放组的(6.82±1.41) cm，术中出血量为(14.12±5.63) mL，明显少于开放组的(28.41±10.75) mL，手术时间为(110.85±23.65) min，明显长于开放组的(97.98±30.69) min，差异均有统计学意义(P<0.05)；腔镜组患者术后不同时间的VAS评分明显低于开放组，差异均有统计学意义(P<0.05)；术前，两组患者的WBC、CRP、IL-6比较差异均无统计学意义(P>0.05)，术后72 h，两组患者的WBC、CRP、IL-6明显上升，与本组术前比较差异均有统计学意义(P<0.05)，但组间比较差异均无统计学意义(P>0.05)；腔镜组患者的总手术并发症发生率为 4.65%，明显低于开放组的 28.95%，差异有统计学意义(P<0.05)；术后3个月，腔镜组患者的美观效果主观满意度、皮肤颜色、手术瘢痕、质地与弹性评分及总分明显高于开放组，差异均有统计学意义(P<0.05)；随访3年，腔镜组的复发及转移率分别为11.63%、9.30%，与开放组的10.53%、7.89%比较，差异均无统计学意义(P>0.05)。结论 腔镜手术治疗甲状腺乳头状癌与开放式手术根治效果相似，且微创，术后疼痛轻微，并发症少，美观效果好，复发和转移率均较低。
      【关键词】 甲状腺乳头状癌；中央区淋巴结清扫；腔镜；开放手术；疗效；预后
      【中图分类号】 R736.1 【文献标识码】 A 【文章编号】 1003—6350（2021）03—0312—04

Application of endoscopic and open central lymph node dissection in papillary thyroid carcinoma.
LUO Zhen-feng 1,YANG Hang 2, LI Heng 2. Department of Otolaryngology Head and Neck Surgery 1, Department of Otorhinolaryngology 2,Shiquan County Hospital, Ankang 725200, Shaanxi CHINA
【Abstract】 Objective To compare the effects of endoscopic and open resection of papillary thyroid carcinomacombined with central lymph node dissection in the treatment of papillary thyroid carcinoma. Methods The study retro-spectively reviewed 81 patients with papillary thyroid carcinoma admitted to Shiquan County Hospital between January2015 and January 2017. Among the patients, 38 cases with open surgery were set as the open group, and 43 cases treatedwith endoscopic surgery were selected as the endoscopic group. The general condition of surgery (length of incision, op-erative time, intraoperative blood loss, number of central lymph nodes removed, extubation time, drainage volume, post-operative hospital stay), visual analogue scale (VAS) scores at different time points after surgery, levels of inflammatoryfactors (white blood cell count [WBC], C-reactive protein [CRP], interleukin-6 [IL-6]) before and after surgery, the inci-dence of surgical complications, cosmetic effects at 3 months after surgery, tumor recurrence rate and metastasis rate dur-ing 3 years of follow-up were compared between the two groups. Results The length of incision of the endoscopicgroup was (2.23±1.18) cm, which was significantly shorter than (6.82±1.41) cm of the open group; the intraoperativeblood loss was (14.12±5.63) mL, significantly less than (28.41±10.75) mL of the open group, and the operative time was(110.85±23.65) min, significantly longer than (97.98±30.69) min of the open group (all P<0.05). The endoscopic grouphad significantly lower VAS scores than the open group at different time points after surgery (all P<0.05). There were nosignificant differences in the WBC, CRP, and IL-6 between the two groups before surgery (all P>0.05), which all in-creased at 72 h after surgery, without significant differences between the two groups (P>0.05). The total incidence of sur-gical complications in the endoscopic group was 4.65%, which was significantly lower than 28.95% in the open group(P<0.05). Three months after surgery, the endoscopic group had significantly higher scores for subjective satisfaction,skin color, surgical scar, texture and elasticity and total score of cosmetic effects than the open group (all P<0.05). Dur-ing 3 years of follow-up, the recurrence and metastasis rates in the endoscopic group were 11.63% and 9.30%, comparedwith 10.53% and 7.89% in the open group (P>0.05). Conclusion Endoscopic surgery for papillary thyroid carcinomacan achieve similar resection effects to open surgery. It is minimally invasive, with mild postoperative pain, few compli-cations, good cosmetic effects, low recurrence, and metastasis rates.
      【Key words】 Papillary thyroid carcinoma (PTC); Central lymph no