经乳晕入路内镜手术在甲状腺乳头状癌治疗中可获得与开放手术相当的肿瘤学切除效果。
The Transareola Endoscopic Approach Yields Adequate Oncological Dissection as Open Approach in the Treatment of Papillary Thyroid Carcinoma.
作者信息
Gao Hengyuan, Chen Chen, Liu Xinjie, Xu Nan, Wang Yuanyang, Qu Rui, Yu Xiaofang
机构信息
Department of Thyroid Surgery, Second Medical Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen.
Department of Thyroid Surgery, First People's Hospital of Zunyi, Zunyi, China.
出版信息
Surg Laparosc Endosc Percutan Tech. 2019 Dec;29(6):489-492. doi: 10.1097/SLE.0000000000000729.
OBJECTIVE
This study aimed to evaluate and discuss whether the transareola endoscopic surgery has similar outcome outcomes to open surgery in the treatment of papillary thyroid carcinoma (PTC).
METHOD
A total of 102 patients with PTC were enrolled in this study. Among them, 53 patients were treated by transareola endoscopic surgery (endoscopic group) and 49 patients were treated by open surgery (open group). Some specific factors, including thyroglobulin (Tg), radioactive iodine uptake (RAIU), postoperative nuclide imaging in thyroid area, postoperative nuclide imaging of lymph nodes suspicious for metastasis (PNILNSM), etc. were analyzed and compared between the 2 groups.
RESULTS
There were no significant differences between the 2 groups regarding body mass index (22.9±3.4 vs. 24.0±3.3, P=0.103), operation time (173.3±43.2 vs. 158.8±47.9 min, P=0.110), intraoperative blood loss (41.8±19.4 vs. 35.8±31.0 mL, P=0.251, P=0.251), tumor diameter (19.0±6.8 vs. 20.2±7.2 mm, P=0.400), and overall complications (11.3% vs. 10.2%, P=0.868). No significant difference was found in the specific factors between the 2 groups concerning RAIU-2h/24h (2.44±1.34 vs. 2.58±1.65%/2.83±3.75 vs. 2.35±3.44%, P=0.646/ P=0.506), number of dissected lymph nodes (4.4±1.4 vs. 4.6±1.5, P=0.595), Tg before radioiodine therapy (4.46±5.50 vs. 5.60±8.36; P=0.495), Tg after radioiodine therapy (1.03±1.93 vs. 1.11±1.61, P=0.812, P=0.812), postoperative nuclide imaging in thyroid area (1.76±1.50 vs. 2.19±1.85 cm, P=0.195), PNILNSM before radioiodine (none: 79.2% vs. 83.7%, P=0.566; central: 17.0% vs. 12.2%, P=0.653; lateral: 1.9% vs. 4.1%, P=0.450; central+lateral: 1.9% vs. 0%, P=1.000), and PNILNSM after radioiodine (none: 94.3% vs. 95.9%, P=0.111; central: 3.8% vs. 2.0%, P=1.000; lateral: 0 vs. 2.0%, P=0.480; central+lateral: 1.9% vs. 0%, P=1.000).
CONCLUSIONS
Transareola endoscopic total thyroidectomy and central lymph nodes dissection are safe and effective. According to the evaluated postoperative specific factors, this technique achieves similar outcomes to open surgery in selected patients with PTC.
目的
本研究旨在评估和探讨经乳晕腔镜手术在治疗乳头状甲状腺癌（PTC）方面的疗效是否与开放手术相似。
方法
本研究共纳入102例PTC患者。其中，53例患者接受经乳晕腔镜手术治疗（腔镜组），49例患者接受开放手术治疗（开放组）。分析并比较两组患者的一些特定因素，包括甲状腺球蛋白（Tg）、放射性碘摄取（RAIU）、甲状腺区域术后核素显像、可疑转移淋巴结术后核素显像（PNILNSM）等。
结果
两组患者在体重指数（22.9±3.4 vs. 24.0±3.3，P = 0.103）、手术时间（173.3±43.2 vs. 158.8±47.9分钟，P = 0.110）、术中出血量（41.8±19.4 vs. 35.8±31.0 mL，P = 0.251）、肿瘤直径（19.0±6.8 vs. 20.2±7.2 mm，P = 0.400）和总体并发症发生率（11.3% vs. 10.2%，P = 0.868）方面无显著差异。两组患者在RAIU-2h/24h（2.44±1.34 vs. 2.58±1.65%/2.83±3.75 vs. 2.35±3.44%，P = 0.646/P = 0.506）、清扫淋巴结数量（4.4±1.4 vs. 4.6±1.5，P = 0.595）、放射性碘治疗前Tg（4.46±5.50 vs. 5.60±8.36；P = 0.495）、放射性碘治疗后Tg（1.03±1.93 vs. 1.11±1.61，P = 0.812）、甲状腺区域术后核素显像（1.76±1.50 vs. 2.19±1.85 cm，P = 0.195）、放射性碘治疗前PNILNSM（无：79.2% vs. 83.7%，P = 0.566；中央区：17.0% vs. 12.2%，P = 0.653；侧区：1.9% vs. 4.1%，P = 0.450；中央区+侧区：1.9% vs. 0%，P = 1.000）以及放射性碘治疗后PNILNSM（无：94.3% vs. 95.9%，P = 0.111；中央区：3.8% vs. 2.0%，P = 1.000；侧区：0 vs. 2.0%，P = 0.480；中央区+侧区：1.9% vs. 0%，P = 1.000）等特定因素方面也无显著差异。
结论
经乳晕腔镜全甲状腺切除术及中央区淋巴结清扫术安全有效。根据评估的术后特定因素，该技术在部分PTC患者中取得了与开放手术相似的疗效。
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