经口内镜甲状腺切除术前庭入路（TOETVA）与传统开放性甲状腺切除术治疗甲状腺全切除术及中央区颈淋巴结清扫术患者的比较：倾向评分匹配分析
Comparison Between Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) and Conventional Open Thyroidectomy for Patients Undergoing Total Thyroidectomy and Central Neck Dissection: A Propensity Score-Matching Analysis.
作者信息
Sun Haiqing, Wang Xiaojie, Zheng Guibin, Wu Guochang, Zeng Qingdong, Zheng Haitao
机构信息
Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China.
Department of Thyroid Surgery, Qilu Hospital of Shandong University, Jinan, China.
出版信息
Front Oncol. 2022 Mar 2;12:856021. doi: 10.3389/fonc.2022.856021. eCollection 2022.
BACKGROUND
Use of the novel transoral endoscopic thyroidectomy vestibular approach (TOETVA) is increasing worldwide. Although several studies have compared safety and efficacy of TOETVA and other approaches, most focused on comparisons in the context of unilateral thyroidectomy. Therefore, the present study aimed to compare the safety and surgical completeness of TOETVA with conventional open thyroidectomy (COT) in patients with papillary thyroid carcinoma (PTC) undergoing total thyroidectomy and central neck dissection.
METHODS
The medical records of patients who underwent TOETVA or COT by a single surgeon between June 2017 and October 2021 were retrospectively reviewed. All patients were diagnosed with PTC and underwent total thyroidectomy with central neck dissection. Propensity score-matching (PSM) was used to reduce potential selection bias and to adjust for differences in baseline clinicopathological characteristics.
RESULTS
After PSM, 84 (TOETVA: 28; COT: 56) patients remained in the study population. There were no significant differences in sex, mean age, combined thyroiditis, tumor size, capsule invasion, tumor multifocality in the same lobe, or tumor location between the groups. Operative time was longer (190.54 ± 28.26 123.93 ± 29.78 min, <0.001), while postoperative drainage volume (161.07 ± 225.30 71.16 ± 28.56 ml, =0.045) was greater, in the TOETVA group than in the COT group. The groups exhibited no significant differences in the mean number of central lymph nodes retrieved (9.39 ± 4.01 10.71 ± 5.17, =0.202), mean number of metastatic central lymph nodes (1.36 ± 1.93 1.77 ± 2.31, =0.421), postoperative mean thyroglobulin levels (0.08 ± 0.24 0.10 ± 0.27, =0.686), rate of transient hypoparathyroidism (TOETVA: 67.9% COT: 66.1%, =0.870), rate of transient vocal cord palsy (TOETVA: 0% COT: 1.8%, =1.000), or other complications (TOETVA: 3.6% COT: 0%, =0.333).
CONCLUSIONS
TOETVA is a safe approach in select patients with PTC and exhibits similar efficacy to COT in terms of surgical completeness.
背景
新型经口内镜甲状腺切除术前庭入路（TOETVA）在全球范围内的应用正在增加。尽管有几项研究比较了TOETVA与其他入路的安全性和有效性，但大多数研究集中在单侧甲状腺切除术背景下的比较。因此，本研究旨在比较TOETVA与传统开放性甲状腺切除术（COT）在接受全甲状腺切除术和中央区淋巴结清扫术的甲状腺乳头状癌（PTC）患者中的安全性和手术完整性。
方法
回顾性分析2017年6月至2021年10月间由同一位外科医生进行TOETVA或COT手术的患者的病历。所有患者均被诊断为PTC，并接受了全甲状腺切除术和中央区淋巴结清扫术。采用倾向评分匹配（PSM）来减少潜在的选择偏倚，并调整基线临床病理特征的差异。
结果
PSM后，84例（TOETVA组：28例；COT组：56例）患者纳入研究人群。两组在性别、平均年龄、合并甲状腺炎、肿瘤大小、包膜侵犯、同一叶内肿瘤多灶性或肿瘤位置方面无显著差异。TOETVA组的手术时间较长（190.54±28.26比123.93±29.78分钟，P<0.001），而术后引流量（161.07±225.30比71.16±28.56毫升，P=0.045）大于COT组。两组在中央区淋巴结清扫的平均数量（9.39±4.01比10.71±5.17，P=0.202）、中央区转移淋巴结的平均数量（1.36±1.93比1.77±2.31，P=0.421）、术后平均甲状腺球蛋白水平（0.08±0.24比0.10±0.27，P=0.686）、暂时性甲状旁腺功能减退的发生率（TOETVA组：67.9%比COT组：66.1%，P=0.870）、暂时性声带麻痹的发生率（TOETVA组：0%比COT组：1.8%，P=1.000）或其他并发症（TOETVA组：3.6%比COT组：0%，P=0.333）方面无显著差异。
结论
TOETVA在特定的PTC患者中是一种安全的入路，在手术完整性方面与COT具有相似的疗效。
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