不同入路腔镜手术治疗单侧甲状腺癌的安全性和效果

Safety and efficacy of different approaches in laparoscopic surgery for unilateral thyroid cancer

摘要

目的：比较经口腔前庭入路、经胸前入路及经锁骨下入路治疗单侧甲状腺癌的安全性和效果。方法：回顾性分析2022年8月—2025年2月在郑州大学附属郑州中心医院甲状腺外科接受经口腔前庭入路（经口组，n=75）、经胸前入路（经胸组，n=75）、经锁骨下入路（经锁骨下组，n=64）行单侧甲状腺癌根治术的患者的临床资料。对3组围手术期各项指标、术后并发症发生情况、术后疼痛情况、颈部功能及手术切口美观满意度进行对比。结果：患者均顺利完成腔镜甲状腺手术，无中转开放手术。经锁骨下组手术时间和住院时间均明显短于经口组与经胸组（P<0.001）；经口组与经锁骨下组中央区淋巴结清扫数量均明显多于经胸组（P<0.001）；经口组和经锁骨下组术后第1天引流量明显少于经胸组（P=0.009）；经口组与经锁骨下组术后3 d颈部损伤评分均明显低于经胸组（P<0.001）；经口组与经锁骨下组术后3 d吞咽障碍评分均明显低于经胸组（P<0.001）；3组温哥华瘢痕评分差异对比均有统计学意义（P<0.001），3组阳性淋巴结数量、术后引流管留置时间、并发症发生率、术后3 d疼痛评分、术后3个月颈部损伤评分、术后3个月吞咽障碍评分差异无统计学意义（P>0.05）。结论：3种腔镜手术方式都是安全、可行的，其中以经口腔前庭入路美容效果最佳，并能达到完全的体表无痕，但是属于Ⅱ类切口，围手术期需应用抗生素预防感染；经胸前入路在根治的前提下又兼具美容效果，切口隐蔽，不影响患者日常穿搭；锁骨下入路手术时间和住院时间短，颈部损伤评分最低，舒适度高，但美容效果较另外两组稍差。不同入路有其各自的利弊，应根据患者具体情况及意愿选择适宜的腔镜手术方式。

Abstract

Objective: To compare the safety and efficacy of transoral vestibular approach, transthoracic approach, and transinfraclavicular approach in the treatment of unilateral thyroid cancer. Methods: A retrospective analysis was conducted on the clinical data of patients who underwent radical resection of unilateral thyroid cancer via transoral vestibular approach (transoral group, n=75), transthoracic approach(transthoracic group, n=75), and transsubclavian approach (subclavian group, n=64) in the Thyroid Surgery Department of Zhengzhou Central Hospital Affiliated to Zhengzhou University from August 2022 to February 2025. General patient characteristics, perioperative indicators, postoperative complications, pain scores, neck function, and cosmetic satisfaction were compared among the three groups. Results: All patients successfully completed laparoscopic thyroid surgery without conversion to open surgery. The operation time and lenth of hospital stay of the subclavian group was significantly shorter than that of the transoral group and the transthoracic group (P<0.001). The number of dissected central lymph nodes in both the transoral group and the subclavian group was significantly higher than that in the transthoracic group (P<0.001). The drainage volume on the first postoperative day in the transoral group and the subclavian group was significantly less than that in the transthoracic group (P=0.009). The cervical injury score on the 3rd postoperative day in the transoral group and the subclavian group was significantly lower than that in the transthoracic group (P<0.001). The dysphagia score on the 3rd postoperative day in the transoral group and the subclavian group was significantly lower than that in the transthoracic group (P<0.001). There were statistically significant differences in the Vancouver Scar Scale scores among the three groups (P<0.05). No statistically significant differences were observed among the three groups in terms of the number of positive lymph nodes, postoperative drainage tube indwelling time, complication rate, pain score on the 3rd postoperative day, cervical injury score at 3 months postoperatively, and dysphagia score at 3 months postoperatively (P>0.05). Conclusions: All three endoscopic approaches are safe and feasible for treating unilateral thyroid cancer. The transoral vestibular approach provides the best cosmetic results with no visible external scars, though it is classified as a Class Ⅱ incision and requires perioperative antibiotic prophylaxis. The transthoracic approach ensures radical resection while providing cosmetic benefits, with hidden incisions that do not affect the patient's daily clothing. The transinfraclavicular approach features the shortest operation time and hospital stay, the lowest neck injury score, and high comfort, though its cosmetic effect is slightly inferior to the other two approaches. Different approaches have their own advantages and disadvantages, and the appropriate laparoscopic surgery method should be selected according to the specific situation and wishes of the patient.

关键词

甲状腺肿瘤 / 甲状腺切除术 / 经口入路 / 经锁骨下入路 / 经胸前入路

Key words

Thyroid neoplasms / Thyroidectomy / Transoral approach / Transinfraclavicular approach / Transthoracic approach

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