Curative effect of unilateral thyroid lobectomy by different approaches in the treatment of papillary thyroid microcarcinoma
10.3760/cma.j.cn.115807-20221229-00389
- VernacularTitle:不同入路行单侧甲状腺叶切除术治疗甲状腺微小乳头状癌的疗效分析
- Author:
Shuming ZHANG
1
;
Dongdong WU
;
Hua ZHANG
;
Geng WANG
Author Information
1. 十堰市太和医院甲乳外科，十堰 442000
- Keywords:
Thyroid carcinoma;
Thyroid micropapillary carcinoma;
Transoral vestibular approach;
Transaxillary approach;
Unilateral thyroidectomy;
Randomized controlled
- From:
Chinese Journal of Endocrine Surgery
2023;17(4):440-444
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the clinical effects of different approaches of unilateral thyroid lobectomy in the treatment of papillary thyroid microcarcinoma (PTMC) .Methods:From Jun. 2019 to Jun. 2022, 70 patients with PTMC from Thyroid and Breast Surgery Department of Taihe Hospital and Dongfeng General Hospital were selected for prospective study. They were divided into transoral group with 35 cases according to random number table method. Trans-oral endoscopic thyroidectomy (TOET) was adopted in 11 males and 24 females, aging (40.71±5.09) years old, ranging from 23 to 60 years old; 35 cases in the trans-axillary group, using trans-axillary approach Endoscopic thyroidectomy by areola approach (ETAA) including 13 males and 22 females, aging (40.25±5.06) years old, ranging from 24 to 59 years old. Perioperative indicators, inflammatory factors, and stress indicators were recorded in the two groups. The level and complications were followed up for 3 months to evaluate the aesthetics of surgical incisions. The comparison of measurement data between groups was performed by independent t test, and the comparison of count data was conducted by χ2 test. Results:The number of lymph nodes dissected and intraoperative blood loss in the oral cavity group were significantly better than those in the axillary group [ (8.71±0.93) vs (6.85±0.82), (23.05±3.51) ml vs (26.14±3.96) ml] ( t=8.88, 3.46, P<0.05) ; The first day after operation, serum norepinephrine (NE) and cortisol (Cor) in the oral cavity group were significantly lower than those in the axillary group [ (275.31±30.41) ng/L vs (300.22±33.25) ng/L, (180.25±19.75) nmol/L vs (205.36±22.41) nmol/L] ( t=3.27, 4.97, P<0.05) ; The first day after operation, the levels of serum C-reactive protein (CRP) and interleukin-6 (IL-6) in the oral cavity group were significantly lower than those in the axillary group [ (7.05±0.86) mg/L vs (8.74±1.02) mg/L, (4.33±0.62) pg/L vs (6.45±0.81) pg/L] ( t=7.49, 12.30, P<0.05) ; there was no significant difference in the incidence of complications between the groups ( P>0.05) ; Three months postoperatively, the aesthetics of the incision in the oral cavity group (94.29%) was significantly higher than that in the axillary group (77.14%) ( χ2=4.20, P<0.05) . Conclusion:When unilateral thyroid lobectomy is performed for papillary thyroid microcarcinoma, the transoral vestibular approach is less invasive than the transaxillary approach, and the effect of lymph node dissection is better, which is beneficial to reduce the surgical stress response of patients, and the aesthetics of the surgical incision are higher.
