Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
Department of Thyroid Surgery, First People's Hospital of Zunyi City, Zunyi, 563000, China.
Surg Endosc. 2018 Dec;32(12):4749-4756. doi: 10.1007/s00464-018-6221-1. Epub 2018 May 14.
An analysis of some special factors was performed to further evaluate and discuss whether endoscopic surgery and traditional open surgery have similar therapeutic outcomes for differentiated thyroid cancer (DTC).
A retrospective study was performed on 76 patients undergoing surgery to treat DTC. Forty patients were treated by endoscopic thyroidectomy via the chest-breast approach (endoscopic group) and thirty-six patients were treated by open surgery (open group). Serum thyroglobulin (sTg), radioactive iodine uptake (RAIU), radioactive technetium uptake (RATU), radionuclide imaging of the thyroid residual area (RITRA), radionuclide imaging of suspicious lymph nodes metastasis (RISLNM), and other general indexes were analyzed and compared between the two groups.
All surgeries were successfully completed in both groups. There were no significant differences between the two groups regarding gender (P = 0.120), postoperative hospital stay (P = 0.766), operation time (P = 0.065), intra-operative blood loss (P = 0.064), tumor diameter (P = 0.059), and overall complications (P = 0.828). Among these complications, there was no significant difference between the two approaches in transient hypoparathryoidism (P = 0.771), transient recurrent laryngeal injury (P = 0.474) and serious neck skin traction sensation (2.5 vs. 0%, P = 1.000). Age and body mass index were lower in the endoscopic group than the open group (P < 0.05). No significant difference was found in special factors between two groups concerning surgical range (P = 0.872), RAIU-2 h/24 h (P = 0.660/P = 0.955), RATU (P = 0.116), number of dissected lymph nodes (P = 0.157), sTg before radioiodine therapy (P = 0.188), sTg after radioiodine therapy (P = 0.159), RITRA at different time points (Tc 15 min: P = 0.144; I 24 h: P = 0.243; I 72 h: P = 0.624) and RISLNM (none: P = 0.805; central: P = 0.744; lateral: P = 1.000; central + lateral: P = 0.958).
Endoscopic total thyroidectomy and central lymph nodes dissection via a chest-breast approach are safe and effective. Through the detection of the postoperative special factors, a well-trained surgeon can achieve similar therapeutic results for selected patients with DTC, compared with open surgery.
本研究分析了一些特殊因素，旨在进一步评估和讨论内镜手术与传统开放手术治疗分化型甲状腺癌（DTC）的疗效是否相似。
回顾性分析 76 例行手术治疗 DTC 的患者资料。40 例行内镜经胸乳入路甲状腺切除术（内镜组），36 例行开放性甲状腺切除术（开放组）。比较两组患者的血清甲状腺球蛋白（sTg）、放射性碘摄取率（RAIU）、放射性锝摄取率（RATU）、甲状腺残留区放射性碘显像（RITRA）、可疑淋巴结转移放射性碘显像（RISLNM）及其他一般指标。
两组患者均顺利完成手术，两组间性别（P=0.120）、术后住院时间（P=0.766）、手术时间（P=0.065）、术中出血量（P=0.064）、肿瘤直径（P=0.059）和总并发症发生率（P=0.828）差异均无统计学意义。其中，两种术式间在短暂性甲状旁腺功能减退（P=0.771）、暂时性喉返神经损伤（P=0.474）和严重颈部皮肤牵引感（2.5%比 0%，P=1.000）方面差异无统计学意义。内镜组的年龄和体质量指数（BMI）均低于开放组（P<0.05）。两组间手术范围（P=0.872）、2 h/24 h 放射性碘摄取率（RAIU-2 h/24 h）（P=0.660/P=0.955）、RATU（P=0.116）、淋巴结清扫数量（P=0.157）、放射性碘治疗前 sTg（P=0.188）、放射性碘治疗后 sTg（P=0.159）、不同时间点 RITRA（Tc 15 min：P=0.144；I 24 h：P=0.243；I 72 h：P=0.624）和 RISLNM（无：P=0.805；中央区：P=0.744；侧区：P=1.000；中央区+侧区：P=0.958）等特殊因素比较差异均无统计学意义。
内镜下经胸乳入路甲状腺全切除及中央区淋巴结清扫术安全有效，通过对术后特殊因素的检测，经验丰富的外科医生可为选择的 DTC 患者带来相似的治疗效果，与开放手术相当。
