Zhu X M, Wang H T, Xue S, Xue H W, Lu Q Y, Chen G, Wang P S
Department of Thyroid Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun 130021, China.
Department of Critical Care Medcine, the First Hospital of Jilin University, Changchun 130021, China.
Zhonghua Wai Ke Za Zhi. 2023 Sep 1;61(9):807-811. doi: 10.3760/cma.j.cn112139-20230208-00056.
To compare the clinical effects of endoscopic thyroidectomy using a modified gasless transsubclavian approach and the traditional neck approach for unilateral papillary thyroid carcinoma (cN0). The clinical data of 135 patients with cN0 papillary thyroid carcinoma who underwent unilateral thyroidectomy in the Department of Thyroid Surgery, the First Hospital of Jilin University from October 2020 to November 2022 were retrospectively analyzed. There were 37 males and 98 females, aging (43.2±8.8) years (range: 21 to 59 years). There were 51 cases using the modified gasless transsubclavian approach (TS group) and 84 cases using the traditional neck approach (TN group). Comparative analyses were performed between the operative results of the 2 groups by -test, Wilcoxon rank sum test, and test. All endoscopic operations were successfully completed without conversion to the traditional neck approach. Compared to the TN group, the TS group had a longer operation time ((IQR)) (73.5 (22.5) minutes 90.0 (30.0) minutes, =-5.831, <0.01), more postoperative drainage (60 (25) ml 95 (45) ml, =-6.275, <0.01), higher hospitalization costs (22 687 (3 488) yuan 26 652 (2 431) yuan, =-6.944, <0.01), and a higher rate of parathyroid autotransplantation (15.5% (13/84) 60.8% (31/51), =29.651, <0.01). There was no significant difference in the total exposure rate of the central compartment, postoperative hospitalization time, the number of dissected lymph nodes, the number of metastatic lymph nodes, C-reactive protein ratio before and after operation, and preoperative and postoperative parathyroid hormone (all >0.05). Endoscopic thyroidectomy using the modified gasless transsubclavian approach is safe for cN0 papillary thyroid carcinoma, with longer operating time, more postoperative drainage, higher hospitalization costs, and more difficulty in preserving the inferior parathyroid gland in situ compared to traditional open surgery.
比较改良免气腹经锁骨下径路内镜甲状腺切除术与传统颈部径路治疗单侧乳头状甲状腺癌（cN0）的临床效果。回顾性分析2020年10月至2022年11月在吉林大学第一医院甲状腺外科行单侧甲状腺切除术的135例cN0乳头状甲状腺癌患者的临床资料。其中男性37例，女性98例，年龄（43.2±8.8）岁（范围：21至59岁）。采用改良免气腹经锁骨下径路（TS组）51例，采用传统颈部径路（TN组）84例。采用t检验、Wilcoxon秩和检验及χ²检验对两组手术结果进行比较分析。所有内镜手术均成功完成，未中转传统颈部径路。与TN组相比，TS组手术时间更长（（IQR））（73.5（22.5）分钟对90.0（30.0）分钟，t=-5.831，P<0.01），术后引流量更多（60（25）ml对95（45）ml，t=-6.275，P<0.01），住院费用更高（22 687（3 488）元对26 652（2 431）元，t=-6.944，P<0.01），甲状旁腺自体移植率更高（15.5%（13/84）对60.8%（31/51），χ²=29.651，P<0.01）。两组中央区总显露率、术后住院时间、清扫淋巴结数量、转移淋巴结数量、手术前后C反应蛋白比值及术前术后甲状旁腺激素比较，差异均无统计学意义（均P>0.05）。改良免气腹经锁骨下径路内镜甲状腺切除术治疗cN0乳头状甲状腺癌安全可行，但与传统开放手术相比，手术时间更长，术后引流量更多，住院费用更高，原位保留甲状旁腺难度更大。
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