经腋窝入路免气腹内镜甲状腺切除术对甲状腺癌患者喉返神经损伤的影响
Effect of gasless endoscopic thyroidectomy through an axillary approach on the recurrent laryngeal nerve injury in patients with thyroid cancer.
作者信息
Chen Dongqi, Bai Bing, Liu Zhaohui, Yu Yongyang
机构信息
Department of General Surgery, The Hospital of Huaqiao University Quanzhou 362021, Fujian, China.
Department of General Surgery, The First Affiliated Hospital of Xiamen University Xiamen 361003, Fujian, China.
出版信息
Am J Transl Res. 2022 Oct 15;14(10):7512-7519. eCollection 2022.
OBJECTIVE
To observe the effect of gasless endoscopic thyroidectomy through an axillary approach (GETAN) on the recurrent laryngeal nerve in patients with thyroid cancer.
METHODS
One hundred and ten patients with thyroid cancer admitted to the department of general surgery, the First Affiliated Hospital of Xiamen University were retrospectively selected as the research subjects. They were divided into an observation group (OG, 55 patients, treated with GETAN) and a control group (CG, 55 patients, treated with conventional radical resection for papillary thyroid cancer). Clinical indicators, pain degree, negative emotions, recurrent laryngeal nerve injury, vocal and swallowing function, and the incidence of complications were compared between the two groups.
RESULTS
In terms of clinical indicators, the operation time, intraoperative blood loss, extubation time, and hospitalization time in the OG were shorter than those of the CG (all P<0.05). The scores of Visual Analogue Scale (VAS) at one, two, and three days after surgery in the OG were lower than those in the CG (all P<0.001). As for the negative emotions, the Self-Rating Anxiety Scale score, and Self-Rating Depression Scale score in the OG were lower than those in the CG (both P<0.001). The incidence of postoperative recurrent laryngeal nerve injury in the OG was lower than that of the CG (P<0.001). Another analysis showed that GETAN was a protective factor against recurrent laryngeal nerve injury in patients with thyroid cancer (P<0.05). The Voice Handicap Index and Swallowing impairment score one week and one month after surgery were lower in the OG than in the CG (all P<0.001). The incidence of postoperative complications such as hypocalcemia, wound infection, and numbness of hands and feet in the OG was lower than that in the CG (all P<0.001).
CONCLUSION
The GETAN approach is able to relieve postoperative pain, anxiety, and depression; reduce the laryngeal recurrent nerve injury; promote the recovery of laryngeal recurrent nerve; and decrease the incidence of vocal and swallowing dysfunction It is worthy of clinical promotion.
目的
观察经腋窝入路非气腹内镜甲状腺切除术（GETAN）对甲状腺癌患者喉返神经的影响。
方法
回顾性选取厦门大学附属第一医院普通外科收治的110例甲状腺癌患者作为研究对象。将其分为观察组（OG，55例，采用GETAN治疗）和对照组（CG，55例，采用甲状腺乳头状癌传统根治性切除术治疗）。比较两组的临床指标、疼痛程度、负面情绪、喉返神经损伤情况、发声及吞咽功能以及并发症发生率。
结果
在临床指标方面，观察组的手术时间、术中出血量、拔管时间和住院时间均短于对照组（均P<0.05）。观察组术后1天、2天和3天的视觉模拟评分（VAS）得分低于对照组（均P<0.001）。在负面情绪方面，观察组的自评焦虑量表得分和自评抑郁量表得分低于对照组（均P<0.001）。观察组术后喉返神经损伤发生率低于对照组（P<0.001）。另一项分析表明，GETAN是甲状腺癌患者喉返神经损伤的保护因素（P<0.05）。观察组术后1周和1个月的嗓音障碍指数和吞咽障碍评分低于对照组（均P<0.001）。观察组术后低钙血症、伤口感染和手脚麻木等并发症发生率低于对照组（均P<0.001）。
结论
GETAN入路能够缓解术后疼痛、焦虑和抑郁；减少喉返神经损伤；促进喉返神经恢复；降低发声和吞咽功能障碍的发生率，值得临床推广。
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