引用本文:唐 杰,历 芝,魏 万,封紫玉,任 毅.颈侧胸锁乳突肌前缘入路术式治疗单侧甲状腺癌的临床效果观察[J].中国临床新医学,2023,16(10):1048-1052.
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颈侧胸锁乳突肌前缘入路术式治疗单侧甲状腺癌的临床效果观察
唐 杰,历 芝,魏 万,封紫玉,任 毅
223300 江苏,南京医科大学附属淮安第一人民医院甲乳外科
摘要:
[摘要] 目的 观察颈侧胸锁乳突肌前缘入路术式治疗单侧甲状腺癌的临床效果。方法 选择2022年8月至2022年12月于南京医科大学附属淮安第一人民医院行单侧甲状腺癌手术治疗的97例患者的临床资料,根据不同入路术式将其分为三组:颈侧组24例,采用颈侧胸锁乳突肌前缘入路术式;正中组50例,采用传统正中切口入路术式;腔镜组23例,采用无充气腋窝入路腔镜术式。比较三组围手术期相关指标、术后美容效果以及并发症发生情况。结果 三组患者术中淋巴结清扫数与淋巴结转移数比较差异无统计学意义(P>0.05)。颈侧组手术时间、术中出血量及术后引流量与正中组比较差异无统计学意义(P>0.05)。颈侧组住院时间显著短于腔镜组(P<0.05)。与颈侧组和正中组相比,腔镜组手术时间、引流管留置时间较长,术中出血量及术后引流量较大,差异均有统计学意义(P<0.05)。在术后1 d,腔镜组视觉模拟量表(VAS)评分高于正中组和颈侧组,差异有统计学意义(P<0.05)。在术后3个月,腔镜组与颈侧组的非外科研讨会(NSS)评分比较差异无统计学意义(P>0.05),均显著高于正中组(P<0.05)。颈侧组的术后总并发症发生率显著低于正中组(8.33% vs 36.00%,P<0.05),与腔镜组比较差异无统计学意义(8.33% vs 21.74%,P>0.05)。结论 与传统正中切口、无充气腋窝入路腔镜术式相比,胸锁乳突肌前缘入路术式能在保证安全的前提下完成单侧甲状腺癌治疗,同时兼顾了切口的美容效果,患者术后并发症较少,值得临床推荐。
关键词:  颈侧胸锁乳突肌前缘入路  正中切口入路  无充气腋窝入路腔镜  甲状腺癌  临床疗效
DOI:10.3969/j.issn.1674-3806.2023.10.13
分类号:R 736.1
基金项目:江苏省高层次卫生人才“六个一工程”拔尖人才项目(编号:LGY2019049)
Observation on the clinical effect of anterior cervical sternocleidomastoid approach on treatment of unilateral thyroid carcinoma
TANG Jie, LI Zhi, WEI Wan, et al.
Department of Breast and Thyroid Surgery, the Affiliated Huai′an No.1 People′s Hospital of Nanjing Medical University, Jiangsu 223300, China
Abstract:
[Abstract] Objective To observe the clinical effect of anterior cervical sternocleidomastoid approach on treatment of unilateral thyroid carcinoma. Methods The clinical data of 97 patients who underwent surgical treatment of unilateral thyroid carcinoma in the Affiliated Huai′an No.1 People′s Hospital of Nanjing Medical University from August 2022 to December 2022 were selected and divided into three groups according to different surgical approaches: the cervical group(24 cases, receiving anterior cervical sternocleidomastoid approach), the median group(50 cases, receiving traditional median incision approach) and the endoscopic group(23 cases, receiving non-inflatable axillary approach endoscopy). The perioperative related indicators, postoperative cosmetic effects and complications were compared among the three groups. Results There were no significant differences in the number of lymph nodes dissected and the number of lymph node metastases among the three groups(P>0.05). There were no significant differences in the operation time, intraoperative blood loss and postoperative drainage volume between the cervical group and the median group(P>0.05). The length of hospital stay in the cervical group was significantly shorter than that in the endoscopic group(P<0.05). Compared with the cervical group and the median group, the endoscopic group had longer operation time and retention time of the drainage tube, and larger intraoperative blood loss and postoperative drainage volume, and the differences were significant(P<0.05). The Visual Analogue Scale(VAS) scores in the endoscopic group were higher than those in the median group and the cervical group 1 day after surgery, and the differences were significant(P<0.05). There were no significant differences in the Non-Surgical Symposium(NSS) scores between the endoscopic group and the cervical group(P>0.05), and their NSS scores were significantly higher than those in the median group 3 months after surgery(P<0.05). The total postoperative complication rate in the cervical group was significantly lower than that in the median group(8.33% vs 36.00%, P<0.05), but there was no significant difference between the cervical group and the endoscopic group(8.33% vs 21.74%, P>0.05). Conclusion Compared with the traditional median incision approach and the non-inflatable axillary approach endoscopy, the anterior cervical sternocleidomastoid approach can ensure the safety and effectiveness for the patients in the treatment of unilateral thyroid carcinoma, while also taking into account the aesthetic effect of the incision, reducing postoperative complications for the patients, and is worthy of clinical recommendation.
Key words:  Anterior cervical sternocleidomastoid approach  Median incision approach  Non-inflatable
axillary approach endoscopy
  Thyroid carcinoma  Clinical effect