免充气腋窝入路腔镜甲状腺手术与传统开放甲状腺手术对甲状腺非微小乳头状癌的有效性与安全性比较

Comparison of Efficacy and Safety between Gasless Transaxillary Endoscopic Thyroidectomy and Traditional Open Thyroidectomy for Non-Micro Papillary Thyroid Carcinoma

摘要: 目的：比较分析免充气腋窝入路腔镜甲状腺手术与传统开放甲状腺手术对甲状腺非微小乳头状癌的有效性与安全性。方法：选取本院2022年4月至2025年3月100例甲状腺非微小乳头状癌患者，随机纳入腔镜组与开放组，每组50例。腔镜组采用免充气腋窝入路腔镜甲状腺手术，开放组采用传统开放甲状腺手术，比较2组的手术指标(手术时间、术中出血量、中央区淋巴结清扫数、术后引流量、术后疼痛程度、术后住院时间)、应激反应指标(ACTH、Cor、NE)、甲状腺激素水平(甲状旁腺激素、血钙)、并发症发生率(喉返神经损伤、喉上神经损伤、甲状旁腺功能减退、皮下积液)。结果：腔镜组手术时间长于开放组，术中出血量、术后引流量、术后疼痛程度评分、术后住院时间少于开放组，P < 0.05；2组中央区淋巴结清扫数比较，P > 0.05。腔镜组术后24 h的ACTH、Cor、NE低于开放组，P < 0.05。腔镜组术后1周的甲状旁腺激素、血钙水平高于开放组，P < 0.05。腔镜组并发症发生率低于开放组，P < 0.05。结论：免充气腋窝入路腔镜甲状腺手术治疗甲状腺非微小乳头状癌的有效性与安全性较好，可改善手术指标，减轻应激反应，改善甲状腺激素水平，减少并发症，值得推行。

Abstract: Objective: To compare the efficacy and safety of gasless axillary approach endoscopic thyroidectomy and traditional open thyroidectomy in the treatment of non-micro papillary thyroid carcinoma. Methods: A total of 100 patients with non-micro papillary thyroid carcinoma admitted to our hospital from April 2022 to March 2025 were randomly divided into the endoscopic group and the open group, with 50 cases in each group. The endoscopic group underwent gasless axillary approach endoscopic thyroidectomy, while the open group received traditional open thyroidectomy. The two groups were compared in terms of surgical indicators (operation time, intraoperative blood loss, number of central lymph node dissections, postoperative drainage volume, postoperative pain degree, postoperative hospital stay), stress response indicators (ACTH, Cor, NE), thyroid hormone levels (parathyroid hormone, serum calcium), and incidence of complications (recurrent laryngeal nerve injury, superior laryngeal nerve injury, hypoparathyroidism, subcutaneous hydrops). Results: The operation time in the endoscopic group was longer than that in the open group, while the intraoperative blood loss, postoperative drainage volume, postoperative pain score, and postoperative hospital stay were shorter than those in the open group (P < 0.05). There was no significant difference in the number of central lymph node dissections between the two groups (P > 0.05). At 24 hours after operation, the levels of ACTH, Cor, and NE in the endoscopic group were lower than those in the open group (P < 0.05). At 1 week after operation, the levels of parathyroid hormone and serum calcium in the endoscopic group were higher than those in the open group (P < 0.05). The incidence of complications in the endoscopic group was lower than that in the open group (P < 0.05). Conclusion: Gasless axillary approach endoscopic thyroidectomy has good efficacy and safety in the treatment of non-micro papillary thyroid carcinoma. It can improve surgical indicators, reduce stress response, optimize thyroid hormone levels, and decrease complications, which is worthy of promotion.