Liu Z D, Li Y J, Yu X, Xiang C, Wang P, Wang Y
Department of Thyroid Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Oct 7;55(10):905-912. doi: 10.3760/cma.j.cn115330-20200520-00430.
To compare the surgical efficacy and cosmetic satisfaction of the transoral endoscopic thyroidectomy by vestibular approach (TOETVA), endoscopic thyroidectomy via bilateral areola approach (BAA), and open thyroidectomy (OT) in the treatment of papillary thyroid carcinoma (PTC) in stage T1b. A total of 178 patients with PTC in stages pT1bN0M0 and pT1bN1aM0 treated from January 2017 to December 2018 were divided into TOETVA group (=59), BAA group (=43), and OT group (=76). The baseline characteristics, relevant indexes of surgical efficacy and follow-up data were compared between the three groups, and also the surgical efficacy indexes were compared between unilateral lobectomy + central lymph node dissection (unilateral lobectomy subgroup) and bilateral lobectomy + central lymph nodes dissection (total resection subgroup). SPSS 19.0 statistical software was used for data analysis. The mean ages of patients in TOETVA group and BAA group were significantly younger than those in OT group, and the proportion of women in TOETVA group and BAA group was significantly higher than that in OT group, all <0.05. None of patients in TOETVA and BAA groups were converted to open surgery. Among TOETVA, BAA and OT groups, there were significant differences in the mean operation time [unilateral lobectomy subgroup: (198.0±45.2) min, (162.0±36.9) min and (79.4±28.6) min, <0.05; total resection subgroup: (230.0±36.0) min, (219.8±68.1) min and (102.8±40.0) min, <0.05], in total drainage volume [unilateral lobectomy subgroup: (195.0±55.6) ml, (178.1±50.4) ml and (127.0±30.1) ml, <0.05; total resection subgroup: (221.1±46.7) ml, (245.3±71.2) ml and (137.7±41.6) ml, <0.05], and the incidence of subcutaneous ecchymosis in TOETVA group or BAA group was higher than that in the OT group [5.1% (3/59), 11.6% (5/43) 0, χ(2)=3.952 and 9.225 respectively, both <0.05]. The mean level of C-reactive protein in TOETVA group was higher than that in OT group [(16.8±10.7) (9.5±6.9), <0.05]. Following-up in the third month after surgery between three groups in cosmetic satisfaction scores [(2.7±0.5) (2.6±0.7) (1.7±0.8)], scar self-consciousness scores (0[0,1] 1[0,2] 2[1,2]), and quality of life scores [(9.1±1.1) (8.9±1.1) (7.5±0.8)], cosmetic satisfaction and quality of life in TOETVA and BAA group were better than that in OT group, in terms of scar self-consciousness: TOETVA<BAA<OT (all <0.05). But there were no significant differences in the levels of Tg or TgAb between three groups for total resection subgroup (all >0.05). The median follow-up time of the three groups was 25 months (TOETVA group), 28 months (BAA group), and 32 months (OT group) respectively, without disease progression. TOETVA and BAA are optional surgical methods for PTC in stages pT1bN0M0 and pT1bN1aM0, with good safety and patient's cosmetic satisfaction.
比较经口前庭入路内镜甲状腺切除术（TOETVA）、经双侧乳晕入路内镜甲状腺切除术（BAA）和开放甲状腺切除术（OT）治疗T1b期甲状腺乳头状癌（PTC）的手术疗效及美容满意度。选取2017年1月至2018年12月收治的178例pT1bN0M0和pT1bN1aM0期PTC患者，分为TOETVA组（=59）、BAA组（=43）和OT组（=76）。比较三组患者的基线特征、手术疗效相关指标及随访数据，同时比较单侧甲状腺叶切除术+中央区淋巴结清扫术（单侧叶切除亚组）和双侧甲状腺叶切除术+中央区淋巴结清扫术（全切除亚组）的手术疗效指标。采用SPSS 19.0统计软件进行数据分析。TOETVA组和BAA组患者的平均年龄显著低于OT组，TOETVA组和BAA组女性比例显著高于OT组，差异均<0.05。TOETVA组和BAA组均无患者转为开放手术。TOETVA组、BAA组和OT组之间，平均手术时间[单侧叶切除亚组：(198.0±45.2)分钟、(162.0±36.9)分钟和(79.4±28.6)分钟，<0.05；全切除亚组：(230.0±36.0)分钟、(219.8±68.1)分钟和(102.8±40.0)分钟，<0.05]、总引流量[单侧叶切除亚组：(195.0±55.6)毫升、(178.1±50.4)毫升和(127.0±30.1)毫升，<0.05；全切除亚组：(221.1±46.7)毫升、(245.3±71.2)毫升和(137.7±41.6)毫升，<0.05]存在显著差异，且TOETVA组或BAA组皮下瘀斑发生率高于OT组[分别为5.1%（3/59）、11.6%（5/43）、0，χ(2)=3.952和9.225，均<0.05]。TOETVA组C反应蛋白平均水平高于OT组[(16.8±10.7) (9.5±6.9)，<0.05]。术后第3个月三组患者的美容满意度评分[(2.7±0.5) (2.6±0.7) (1.7±0.8)]、瘢痕自我意识评分（0[0,1] 1[0,2] 2[1,2]）及生活质量评分[(9.1±1.1) (8.9±1.1) (7.5±0.8)]比较，TOETVA组和BAA组的美容满意度和生活质量优于OT组，在瘢痕自我意识方面：TOETVA<BAA<OT（均<0.05）。但全切除亚组三组患者的Tg或TgAb水平比较差异无统计学意义（均>0.05）。三组患者的中位随访时间分别为25个月（TOETVA组）、28个月（BAA组）和32个月（OT组），均无疾病进展。TOETVA和BAA是pT1bN0M0和pT1bN1aM0期PTC的可选手术方法，安全性好，患者美容满意度高。
