Abstract：Objective To compare the clinical efficacy and safety between endoscopic transareolar approach and open surgery in complex thyroid surgery. Methods A total of 83 patients who underwent complex thyroid surgery in Rugao People’s Hospital, Jiangsu Province from January 2018 to May 2021 were selected, and they were divided into study group (endoscopic via areola approach, 43 cases) and control group (open surgery, 40 cases) according to different surgical methods. Surgery time, intraoperative blood loss, and hospital stay were compared between the two groups. The stress response related indexes of the two groups were compared 30 min before surgery, 6 h after surgery, and 12 h after surgery. Visual analogue scale (VAS) and Vancouver scar rating scale (VSS) scores were compared between the two groups. The perioperative complications of the two groups were recorded. Results The amount of intraoperative blood loss in the study group was lower than that in the control group, and the length of hospital stay was shorter than that in the control group, the differences were statistically significant (P ＜ 0.05). There were statistically significant differences in cortisol (Cor), angiotensin Ⅱ (AngⅡ), and adrenaline levels between the two groups at each time point (P ＜ 0.05). The levels of Cor, Ang Ⅱ, and adrenaline in the study group at 6 and 12 h after surgery were lower than those in the control group at the same time point, the differences were statistically significant (P ＜ 0.05). VAS and VSS scores of the study group were lower than those of the control group, and the differences were statistically significant (P ＜ 0.05). The total incidence of perioperative complications in the study group was lower than that in the control group, the difference was statistically significant (P ＜ 0.05). Conclusion Compared with open surgery, endoscopic surgery through areola approach for complex thyroid can guarantee the therapeutic effect and reduce intraoperative blood loss, shorten the length of hospital stay, relieve stress reaction, relieve postoperative pain, improve aesthetic value, and reduce postoperative complications.
徐方正 马伯恒▲. 腔镜下经乳晕入路与开放手术在复杂甲状腺手术中的临床效果及安全性比较[J]. 中国医药导报, 2022, 19(9): 79-82.
XU Fangzheng MA Boheng▲. Comparison of clinical efficacy and safety between endoscopic transareolar approach and open surgery in complex thyroid surgery#br#. 中国医药导报, 2022, 19(9): 79-82.
[1] Kurimoto C，Inaba H，Ariyasu H，et al. Predictive and sensitive biomarkers for thyroid dysfunctions during treatment with immune-checkpoint inhibitors [J]. Cancer Sci，2020，111（5）：1468-1477.
[2] 郭卫红，刘曙艳.微波消融与手术切除治疗甲状腺良性结节疗效和机体应激反应程度的比较[J].安徽医药，2019，23（1）：10-14.
[3] Pistollato F，Masias M，Agudo P，et al. Effects of phytochemicals on thyroid function and their possible role in thyroid disease [J]. Ann N Y Acad Sci，2019，1443（1）：3-19.
[4] 高博，何渝军，徐琰，等.多学科协作模式在复杂疑难甲状腺肿瘤诊治中的应用[J].中华内分泌外科杂志，2017， 11（4）：278-282.
[5] 王平，燕海潮.腔镜技术在复杂甲状腺手术治疗的应用及体会[J].医学与哲学，2015，8（10）：13-15.
[6] An L，Hwang KS，Park SH，et al. Trends of robotic-assisted surgery for thyroid，colorectal，stomach and hepatopancreaticobiliary cancer：10 year Korea trend investigation [J]. Asian J Surg，2021，44（1）：199-205.
[7] 向光大.临床甲状腺病学[M].北京：人民卫生出版社，2013：21-23.
[8] 张永旺.现代甲状腺疾病诊断与治疗[M].西安：陕西科学技术出版社，2012：36-37.
[9] Faiz KW. VAS——visual analog scale [J]. Tidsskr Nor Laegeforen，2014，134（3）：323.
[10] Chae JK，Kim JH，Kim EJ，et al. Values of a Patient and Observer Scar Assessment Scale to Evaluate the Facial Skin Graft Scar [J]. Ann Dermatol，2016，28（5）：615-623.
[11] Li Q，Wang B，Mu K，et al. The pathogenesis of thyroid autoimmune diseases：New T lymphocytes-Cytokines circuits beyond the Th1-Th2 paradigm [J]. J Cell Physiol，2019，234（3）：2204-2216.
[12] Riley AS，McKenzie G，Green V，et al. The effect of radioiodine treatment on the diseased thyroid gland [J]. Int J Radiat Biol，2019，95（12）：1718-1727.
[13] 郭浩伟，甄林林.甲状腺结节的超声诊断特征分析与研究[J].中国医药导报，2019，16（4）：149-152.
[14] 薛明淼，尚梦园，王志化，等.良恶性甲状腺结节的临床特点分析[J].中国医药科学，2020，10（21）：14-17.
[15] 张爽.腔镜技术应用于复杂甲状腺手术治疗价值评价[J].黑龙江医药，2018，31（1）：155-157.
[16] 黄国祥，谢楚平，陈思远.腔镜辅助小切口手术治疗甲状腺良性结节患者的疗效分析[J].中国医药科学，2021， 11（14）：147-150.
[17] Koimtzis GD，Papavramidis TS. Proper handling of the pyramidal lobe in minimal access thyroid procedures [J]. Endocrine，2019，65（3）：520-523.
[18] Chew CR，Chin SL，Lam T，et al. How does thyroidectomy for benign thyroid disease impact upon quality of life a prospective study [J]. ANZ J Surg，2020，90（12）：E177-E182.
[19] 侯建忠，张颖超，樊友本，等.全乳晕腔镜手术与传统开放手术治疗甲状腺癌临床效果的Meta分析[J].腹腔镜外科杂志，2020，5（5）：7-13.
[20] 刘聪.传统甲状腺切除术与超声刀开放甲状腺切除术的临床效果比较[J].中国当代医药，2020，27（4）：47-49.
[21] 李俊生.经胸乳晕入路腔镜与传统开放手术治疗CNO stage期甲状腺癌的临床效果[J].贵阳医学院学报，2018，43（6）：712-715.
[22] Nguyen BK，Stathakios J，Quan D，et al. Perioperative Analgesia for Patients Undergoing Thyroidectomy and Parathyroidectomy: An Evidence-Based Review [J]. Ann Otol Rhinol Laryngol，2020，129（10）：949-963.
[23] Lang B，Woo YC，Chiu KW. Effect of perithyroidal lignocaine infusion to pain experienced during high-intensity focused ultrasound ablation of benign thyroid nodules [J]. Eur Radiol，2019，29（10）：5280-5287.
[24] Liu SY，Guo WH，Yang B，et al. Comparison of stress response following microwave ablation and surgical resection of benign thyroid nodules [J]. Endocrine，2019，65（1）：138-143.
[25] White OB，Clough M，McKendrick AM，et al. Visual Snow: Visual Misperception [J]. J Neuroophthalmol，2018，38（4）：514-521.
[26] 王中林，饶尚锐，林哲，等.全乳晕入路腔镜手术与开放手术在甲状腺乳头状癌中的应用研究[J].中国医师进修杂志，2018，41（8）：691-695.
[27] 吴千富，甘水，刘雪莹，等.分析经乳晕入路腔镜甲状腺切除术与开放甲状腺切除治疗良性甲状腺病变的临床疗效对比[J].中国医疗设备，2017，15（32）：184.
[28] 朱楷，喻昆霖，金钟奎，等.经乳晕切口全腔镜下甲状腺肿瘤切除手术的临床应用研究[J].中国当代医药，2021， 28（27）：101-103.
[29] 戴萦企，张金庆.经全乳晕入路腔镜甲状腺切除术对良性甲状腺病变患者应激相关激素水平的影响[J].河北医学，2020，26（9）：1464-1469.
[30] Johri G，Chand G，Mishra A，et al. Endoscopic versus Conventional Thyroid Surgery：A Comparison of Quality of Life，Cosmetic Outcomes and Overall Patient Satisfaction with Treatment [J]. World J Surg，2020，44（12）：4118-4126.
京公网安备 11010502046598号