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目的:评价经腋下径路无注气内镜下甲状腺微小乳头状癌手术的可行性、安全性及有效性。方法:回顾性分析39例甲状腺微小乳头状癌患者经腋下径路无注气内镜下手术(内镜组)临床资料,以同期相同诊断78例患者行开放手术(开放组)作为对照,分析内镜组和传统组的手术时间、手术出血量、肿瘤大小、淋巴结清扫个数、淋巴结阳性个数、淋巴结阳性率、引流量、术后住院时间、术后并发症发生率、肿瘤复发率及术后3个月时随访美观满意度等指标。结果:内镜组手术时间较传统组长(86.15±12.54 min vs.50.64±8.03 min,),引流量较传统组多(82.33±21.98ml vs.69.60±16.44ml),术后3个月美容评分较传统组低(1.05±0.22 vs.3.90±1.20),差异均有统计学意义(t=16.730,P<0.05;t=3.213,P=0.002;t=14.673,P<0.001)。两组间手术出血量、肿瘤大小、淋巴结清扫个数、淋巴结阳性个数、淋巴结阳性率、暂时性喉返神经麻痹发生率和暂时性低钙血症发生率及术后疼痛评分差异无统计学意义,两组患者术后随访未见肿瘤复发或转移。结论:经腋下径路无注气内镜下甲状腺微小乳头状癌手术安全、可行、有效,美容效果优于传统手术,可为有美观需求的部分甲状腺微小乳头状癌患者提供新的选择。
OBJECTIVE: To evaluate the feasibility, safety and efficacy of non-insufflation endoscopic thyroidectomy for small papillary carcinoma through the axillary path. Methods: A retrospective analysis of 39 cases of thyroid papillary thyroid carcinoma patients undergoing non-gastroscopic endoscopic surgery (endoscopy group) clinical data, the same period the same diagnosis of 78 patients underwent open surgery (open group) as a control, analysis The operation time, blood loss, tumor size, number of lymph node dissection, number of lymph node positive, lymph node positive rate, drainage, postoperative hospital stay, postoperative complication rate, tumor recurrence rate, After 3 months of follow-up aesthetic satisfaction and other indicators. Results: The operation time of the endoscopic group was longer (86.15 ± 12.54 min vs. 50.64 ± 8.03 min) than that of the traditional group (82.33 ± 21.98 ml vs.69.60 ± 16.44 ml) The score was lower than the traditional group (1.05 ± 0.22 vs. 3.90 ± 1.20, t = 16.730, P <0.05; t = 3.213, P = 0.002; t = 14.673, P <0.001). The amount of operative bleeding, tumor size, number of lymph node dissection, lymph node positive number, lymph node positive rate, incidence of transient laryngeal nerve paralysis and temporary hypocalcemia and postoperative pain score between the two groups had no statistical significance Significance, no recurrence or metastasis of the two groups were followed up. Conclusion: It is safe, feasible and effective to treat thymic glandular papillary carcinoma without under endoscopy through axillary path. It is superior to traditional surgery in the cosmetic treatment and can provide new options for patients with partial thyroid papillary carcinoma.