山东大学耳鼻喉眼学报 ›› 2025, Vol. 39 ›› Issue (4): 161-167.doi: 10.6040/j.issn.1673-3770.0.2025.100

• 论著 • 上一篇    下一篇

腋窝入路腔镜手术和传统颈部开放手术治疗T1甲状腺癌的安全性和有效性对比研究

张中华1,王辉1,王俊鑫1,张美玲1,张建1,张恩东1,潘新良2   

  1. 1.青岛大学附属威海市立第二医院 耳鼻咽喉头颈外科, 山东 威海 264200;
    2.山东大学齐鲁医院 耳鼻咽喉头颈外科, 山东 济南 250012
  • 出版日期:2025-07-20 发布日期:2025-08-11
  • 通讯作者: 张中华. E-mail:zhangzhonghua@qdu.edu.cn

Comparison of safety and efficacy between transaxillary endoscopic thyroidectomy and conventional open thyroidectomy for Stage T1 thyroid carcinoma

ZHANG Zhonghua1, WANG Hui1, WANG Junxin1, ZHANG Meiling1, ZHANG Jian1, ZHANG Endong1, PAN Xinliang2   

  1. 1. Department of Otorhinolaryngology & Head and Neck Surgery, Affiliated Weihai Second Municipal Hospital of Qingdao University, Weihai 264200, Shandong, China2. Department of Otorhinolaryngology & Head and Neck Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
  • Online:2025-07-20 Published:2025-08-11

PDF (PC)

50

摘要： 目的 探讨腋窝入路腔镜手术与传统颈部开放手术在T1期甲状腺癌治疗中的安全性和有效性。 方法 从 2022年7月16日至2024年7月16日进行的单侧T1期甲状腺乳头状癌手术病例中,采用倾向性评分匹配方法将患者分为实验组(经腋腔镜手术组)和对照组(传统开放手术组),每组各50例。比较两组病例手术时间、术中出血量、淋巴结清扫数目、术后住院时间、住院费用、术后颈部疼痛程度、术后并发症发生率、颈部形态满意度。 结果 与对照组相比,实验组手术时间、住院费用及颈部形态满意度均高于对照组,差异有统计学意义(P均<0.05)。实验组术后颈部疼痛程度明显低于对照组,差异有统计学意义(Z=-4.22,P<0.001)。两组患者术中出血量、淋巴结清扫数目、淋巴结阳性检出率、术后住院时间及术后并发症发生率方面差异无统计学意义(P均>0.05)。术后随访6个月至2年,两组患者均无肿瘤复发。 结论 经腋窝无充气腔镜甲状腺手术可有效根治早期甲状腺乳头状癌,且与传统颈部开放手术相比,其颈部美容效果显著,且术后颈部疼痛明显减轻,可在一定程度上提高患者术后的生活质量。

关键词: T1甲状腺癌, 甲状腺癌根治术, 无充气腋窝入路腔镜手术, 传统颈部开放手术

Abstract: Objective The objective of this study is to compare the safety and efficacy of transaxillary non-inflatable endoscopic thyroidectomy versus conventional open thyroidectomy in the treatment of stage T1 thyroid carcinoma. Methods A retrospective analysis was performed on 50 patients who underwent transaxillary non-inflatable endoscopic thyroidectomy(experimental group)and 50 patients who received conventional open thyroidectomy(control group). Patients were selected from cases of stage T1 thyroid carcinoma between July 16, 2022 and July 16, 2024. Using propensity score matching(1∶1 ratio)based on gender, age, body mass index, tumor size, and tumor location. Comparison of operative outcomes between the two groups included: operative time, intraoperative blood loss, number of lymph nodes harvested, positive lymph nodes detection rate, postoperative hospitalization time, hospitalization costs, postoperative neck pain(assessed by VRS-5), complication rates, and neck cosmetic satisfaction. Results The operation time, hospitalization costs and satisfaction with the neck appearance of the experimental group were significantly higher than those of the control group, and the differences were statistically significant(both P<0.05). The experimental group showed significantly lower postoperative neck pain intensity compared to the control group, with a statistically significant difference(Z=-4.22, P<0.001). No statistically significant differences were observed in intraoperative blood loss, number of lymph nodes harvested, positive lymph nodes detection rate, postoperative hospitalization time, or complication rates(both P>0.05). During follow-up(6-24 months), no tumor recurrence occurred in either group. Conclusion Transaxillary non-inflatable endoscopic thyroidectomy has been shown to provide an effective radical treatment for stage T1 thyroid carcinoma. In comparison with the conventional open thyroidectomy, this approach has been shown to yield superior cosmetic outcomes, significantly reduce postoperative neck pain, and may enhance patients' quality of life.

Key words: Stage T1 thyroid carcinoma, Thyroidectomy, Transaxillary non-inflatable endoscopic thyroidectomy, Conventional open thyroidectomy

中图分类号: 

  • R653
[1] 郑传铭, 王佳峰, 吕恬, 等. “中国肿瘤整合诊治指南(CACA)——甲状腺癌诊治指南”解读[J]. 肿瘤学杂志, 2022, 28(8): 627-630. doi: 10.11735/j.issn.1671-170X.2022.08.B001 ZHENG Chuanming, WANG Jiafeng, LYU Tian, et al. Interpretations on the CACA guidelines for holistic integrative management of cancer——thyroid cancer[J]. Journal of Chinese Oncology, 2022, 28(8): 627-630. doi: 10.11735/j.issn.1671-170X.2022.08.B001
[2] 江春容, 李振华, 张卫卫, 等. 无充气腋窝入路腔镜甲状腺手术治疗甲状腺癌临床疗效的Meta分析[J]. 腹腔镜外科杂志, 2023, 28(12): 881-888. doi:10. 13499/j. cnki. fqjwkzz.2023.12.881 JIANG Chunrong, LI Zhenhua, ZHANG Weiwei, et al. The clinical efficacy of endoscopic thyroidectomy for thyroid carcinoma in gasless axillary approach: a meta-analysis[J]. Journal of Laparoscopic Surgery, 2023, 28(12): 881-888. doi:10. 13499/j. cnki. fqjwkzz.2023.12.881
[3] 中国抗癌协会甲状腺癌专业委员会,中华医学会肿瘤学分会甲状腺肿瘤专业委员会,中国研究型医院学会甲状腺疾病专业委员会,等.无充气腋窝入路腔镜甲状腺手术专家共识(2022版)[J].中华内分泌外科杂志, 2021, 15(6): 557-563. doi: 10.3760/cma. j. cn. 115807-20211116-00349
[4] Abramovici L, Cartier C, Pierre G, et al. Robot-assisted transaxillary thyroidectomy: surgical technique[J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2015, 132(3): 153-156. doi:10.1016/j.anorl.2015.04.002
[5] 王平, 马军杰, 谢秋萍. 腔镜甲状腺手术入路的选择[J]. 中华耳鼻咽喉头颈外科杂志, 2023, 58(9): 926-929. doi:10.3760/cma.j.cn115330-20221228-00777 WANG Ping, MA Junjie, XIE Qiuping. Selection of endoscopic thyroidectomy approaches[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2023, 58(9): 926-929. doi: 10.3760/cma.j.cn115330-20221228-00777
[6] Li XS, Ding W, Zhang H. Surgical outcomes of endoscopic thyroidectomy approaches for thyroid cancer: a systematic review and network meta-analysis[J]. Front Endocrinol(Lausanne), 2023, 14: 1256209. doi:10.3389/fendo.2023.1256209
[7] 中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会,海峡两岸医药卫生交流协会海西甲状腺微创美容外科专家委员会, 等. 经胸前入路腔镜甲状腺手术专家共识(2017版)[J].中国实用外科杂志, 2017, 37(12): 1369-1373. doi:10.19538/j.cjps.issn1005-2208.2017.12.14
[8] 王平, 吴国洋, 田文, 等. 经口腔前庭入路腔镜甲状腺手术专家共识(2018版)[J]. 中国实用外科杂志, 2018, 38(10): 1104-1107. doi:10.19538/j.cjps.issn1005-2208.2018.10.02 WANG Ping, WU Guoyang, TIAN Wen, et al. Expert consensus of endoscopic thyroid surgery via oral vestibular approach(2018 edition)[J]. Chinese Journal of Practical Surgery, 2018, 38(10): 1104-1107. doi:10.19538/j.cjps.issn1005-2208.2018.10.02
[9] Jasaitis K, Midlenko A, Bekenova A, et al. Transaxillary gasless endoscopic thyroidectomy versus conventional open thyroidectomy: systematic review and meta-analysis[J]. Wideochir Inne Tech Maloinwazyjne, 2021, 16(3): 482-490. doi:10.5114/wiitm.2021.105722
[10] 郑传铭, 徐加杰, 蒋烈浩, 等. 无充气腋窝入路完全腔镜下甲状腺叶切除的方法: 葛-郑氏七步法[J]. 中国普通外科杂志, 2019, 28(11): 1336-1341. doi:10.7659/j.issn.1005-6947.2019.11.003 ZHENG Chuanming, XU Jiajie, JIANG Liehao,et al. Endoscopic thyroid lobectomy by a gasless unilateral axillary approach: Ge & Zheng's seven-step method[J]. China Journal of General Surgery, 2019, 28(11): 1336-1341. doi:10.7659/j.issn.1005-6947.2019.11.003
[11] Zhou YQ, Cai YC, Sun RH, et al. Gasless transaxillary endoscopic thyroidectomy for unilateral low-risk thyroid cancer: Li's six-step method[J]. Gland Surg, 2021, 10(5): 1756-1766. doi:10.21037/gs-21-257
[12] 中华人民共和国国家卫生健康委员会医政医管局.甲状腺癌诊疗指南(2022年版)[J].中国实用外科杂志, 2022, 42(12): 1343-1357. doi:10.19538/j.cjps.issn1005-2208.2022.12.02 National Health Commission of the People's Republic of China Medical Administration and Hospital Administration. Guidelines for the diagnosis and treatment of thyroid carcinoma[J]. Chinese Journal of Practical Surgery, 2022, 42(12): 1343-1357. doi:10.19538/j.cjps.issn1005-2208.2022.12.02
[13] 陈孝磊, 李超, 周雨秋, 等. 经腋无充气腔镜与传统颈部开放手术治疗PTC的疗效分析[J]. 中华耳鼻咽喉头颈外科杂志, 2023, 58(4): 351-357.doi: 10.3760/cma.j.cn115330-20220818-00514 CHEN Xiaolei, LI Chao, ZHOU Yuqiu, et al. A comparative study for the efficacies of transaxillary non-inflatable endoscopic surgery versus traditional surgery for papillary thyroid carcinoma[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2023, 58(4): 351-357. doi: 10.3760/cma.j.cn115330-20220818-00514
[14] 孙长华, 刘根祥. 经腋窝免充气腔镜与传统开放甲状腺手术的对比分析[J].腹腔镜外科杂志, 2023, 28(12): 889-892. doi:10.13499/j.cnki.fqjwkzz.2023.12.889 SUN Changhua, LIU Genxiang. Comparison analysis of transaxillary gasless endoscopic versus conventional open thyroid surgery[J]. Journal of Laparoscopic Surgery, 2023, 28(12): 889-892. doi:10.13499/j.cnki.fqjwkzz.2023.12.889
[15] 中国医师协会外科医师分会甲状腺外科医师委员会,中国研究型医院学会甲状腺疾病专业委员会甲状腺手术学组,中国中西医结合学会普通外科专业委员会甲状腺与甲状旁腺专家委员会.局部晚期甲状腺癌手术治疗中国专家共识(2020版)[J].中国实用外科杂志, 2020, 40(4): 369-376. doi:10.19538/j.cjps.issn1005-2208.2020.04.02
[1] 仇继兵,尹燕泽,马敬. 茎突截短术改善茎突综合征咽痛症状八例[J]. 山东大学耳鼻喉眼学报, 2017, 31(6): 71-73.
[2] 张勇,李益飞,程友,季寒. 双内瘘口型不完全性第三鳃裂瘘诊治分析并文献复习[J]. 山东大学耳鼻喉眼学报, 2017, 31(6): 98-100.
[3] 黄天桥,姜晓丹,车飞,黄沂传,孙彦,张念凯,李慎玲,陈志俊,李薇. 术后第一天甲状旁腺激素水平对甲状腺全切术后甲状旁腺功能恢复的预测价值[J]. 山东大学耳鼻喉眼学报, 2017, 31(5): 89-91.
[4] 魏宁,赵雪,刘岩,刘悦,金春顺. 颈部Castleman病两例报告[J]. 山东大学耳鼻喉眼学报, 2017, 31(2): 123-126.
[5] 孙臻峰,张佳,苏甜甜,董频. 急性扁桃体炎致甲状腺脓肿、咽旁间隙脓肿一例并文献复习[J]. 山东大学耳鼻喉眼学报, 2016, 30(6): 58-60.
[6] 王宇,马奔. 超声引导下热消融技术尚不适用于甲状腺癌及甲状腺滤泡性肿瘤治疗[J]. 山东大学耳鼻喉眼学报, 2016, 30(2): 20-22.
[7] 陈恩宽1，王跃建2，宋文光1，庄颖颖2，郑立岗2，陈伟雄2，汪雷2 . 去部分黏膜游离空肠重建气管缺损肠黏膜组织学变化研究[J]. 山东大学耳鼻喉眼学报, 2011, 25(1): 72-76.
[8] 肖二彬. 气管切开术后并发出血14例[J]. 山东大学耳鼻喉眼学报, 2010, 24(3): 57-58.
[9] 沈伟林，李兆生. 颈深部异物诊治4例[J]. 山东大学耳鼻喉眼学报, 2009, 23(5): 54-55.
[10] 李育广 刘凤英. 手术治疗甲状舌管囊肿与瘘管65例[J]. 山东大学耳鼻喉眼学报, 2008, 22(6): 575-576.
[11] 刘联合 . 颈深部脓肿37例[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 180-181 .
[12] 成立新,沈 毅,周新华 . 甲状腺Hurthle细胞瘤11例[J]. 山东大学耳鼻喉眼学报, 2008, 22(1): 35-36 .
[13] 康宏建,李晓红,王保安,周 涛 . 重型颅脑损伤患者行气管切开术的意义[J]. 山东大学耳鼻喉眼学报, 2007, 21(3): 234-236 .
[14] 赵雪柠,叶 萍 , 潘新良,雷大鹏 . 晚期甲状腺癌累及喉、气管和食管的外科治疗[J]. 山东大学耳鼻喉眼学报, 2007, 21(3): 260-262 .
[15] 吴柳青,梁正中,唐向荣 . 小儿气管切开术并发症原因分析[J]. 山东大学耳鼻喉眼学报, 2007, 21(2): 163-165 .
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 杨长亮,黄治物,姚行齐,诸勇,孙艺 . 正常气骨导听性脑干反应及其应用[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 9 -13 .
[2] 王红霞,王鹏程 . NSE、S100及GFAP在视网膜母细胞瘤中的表达及意义[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 263 -264 .
[3] 黄 方,黄海琼,黄建强,何荷蕃 . 支气管内镜视频监视系统在小儿气管-支气管异物诊治中的应用[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 276 -277 .
[4] 于志良,王卫卫,王明华 . 耳鼻喉综合动力系统切除会厌囊肿23例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 278 -279 .
[5] 张剑利,王跃建,陈伟雄,胡维维,李广民 . 免疫组化和连续切片在检测头颈鳞癌颈淋巴结微转移中的意义[J]. 山东大学耳鼻喉眼学报, 2008, 22(4): 299 -303 .
[6] 王洪江,李培华,刘 稳 . 鼻咽部炎性肌纤维母细胞瘤1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2008, 22(4): 331 -332 .
[7] 刘凤安,陈宏杰,胡洪义,郑世信 . 人工耳蜗植入术后听觉言语效果的影响因素[J]. 山东大学耳鼻喉眼学报, 2008, 22(4): 333 -335 .
[8] 丁吉江,李永团,范洪江,薛卫国,郭朝斌 . 双侧鼻结石并鼻中隔穿孔1例[J]. 山东大学耳鼻喉眼学报, 2008, 22(4): 349 -349 .
[9] 陈凤华,马建民,王宁利,王津津 . 人Tenon′s囊成纤维细胞的离体培养及生长特性观察[J]. 山东大学耳鼻喉眼学报, 2008, 22(4): 350 -352 .
[10] 和守盰,陈 斌,殷善开,苏开明,姜 晓 . OSAHS患者UPPP手术前后上气道形态学变化[J]. 山东大学耳鼻喉眼学报, 2008, 22(5): 385 -388 .
网站版权所有 © 2018 《山东大学耳鼻喉眼学报》编辑部　
地址：山东省济南市山大南路27号（250100）电话：+86-0531-88366912 E-mail: ebhxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发