Objective: To compare the efficacies between open surgery and axillary non-inflatable endoscopic surgery in papillary thyroid carcinoma (PTC). Methods: A retrospective analysis was performed on 343 patients with unilateral PTC treated by traditional open surgery (201 cases) and transaxillary non-inflating endoscopic surgery (142 cases) from May 2019 to December 2021 in the Head and Neck Surgery of Sichuan Cancer Hospital. Among them, 97 were males and 246 were females, aged 20-69 years. 1∶1 propensity score matching (PSM) was performed on the enrolled patients, and the basic characteristics, perioperative clinical outcomes, postoperative complications, postoperative quality of life (Thyroid Cancer-Specific Quality of Life), aesthetic satisfaction and other aspects of the two groups were compared after successful matching. SPSS 26.0 software was used for statistical analysis. Results: A total of 190 patients were enrolled after PSM, with 95 cases in open group and 95 cases in endoscopic group. Intraoperative blood losses for endoscopic and open groups were [20 (20) ml vs. 20 (10) ml, M (IQR), Z=-2.22], postoperative drainage volumes [170 (70)ml vs. 101 (55)ml, Z=-7.91], operative time [135 (35)min vs. 95 (35)min, Z=-7.34], hospitalization cost [(28 188.7±2 765.1)yuan vs. (25 643.5±2 610.7)yuan, x¯±s, t=0.73], postoperative hospitalization time [(3.1±0.9)days vs. (2.6±0.9)days, t=-3.24], and drainage tube placement time [(2.5±0.8) days vs. (2.0±1.0)days, t=-4.16], with statistically significant differrences (all P<0.05). There was no significant difference in surgical complications (P>0.05). There were significant diffferences between two groups in the postoperative quality of life scores in neuromuscular, psychological, scar and cold sensation (all P<0.05), while there were no statistically significant differences in other quality of life scores (all P>0.05). In terms of aesthetic satisfaction 6 months after surgery, the endoscopic group was better than the open group, with statistically significant difference (χ2=41.47, P<0.05). Conclusion: Endoscopic thyroidectomy by a gasless unilateral axillary approach is a safe and reliable surgical method, which has remarkable cosmetic effect and can improve the postoperative quality of life of patients compared with the traditional thyroidectomy.
目的： 比较经腋无充气腔镜与开放术式在甲状腺乳头状癌（PTC）的疗效及术后生活质量的差异。 方法： 回顾性分析四川省肿瘤医院头颈外科2019年5月至2021年12月采用经腋无充气腔镜手术（142例）与传统颈部开放手术（201例）治疗单侧PTC的343例患者的病例资料，其中男性97例，女性246例，年龄20~69岁。对入组患者进行1∶1倾向评分匹配（PSM），对匹配成功后的2组患者的基本特征、围手术期临床结果、术后并发症、术后生活质量（采用甲状腺癌特异性生活质量量表）、美观满意度等方面进行比较。应用SPSS 26.0软件进行统计学分析。 结果： PSM后共纳入190例患者，腔镜组和开放组各95例，在术中失血量［20（20）ml比20（10）ml，M（IQR），下同，Z=-2.22］、术后引流量［170（70）ml比101（55）ml，Z=-7.91］、手术时间［135（35）min比95（35）min，Z=-7.34］、住院费用［（28 188.7±2 765.1）元比（25 643.5±2 610.7）元，x¯±s，下同，t=0.73］、术后住院时间［（3.1±0.9）d比（2.6±0.9）d，t=-3.24］、引流管放置时间［（2.5±0.8）d比（2.0±1.0）d，t=-4.16］，腔镜组患者高于开放组，差异均有统计学意义（P值均<0.05）；在手术并发症方面差异无统计学意义（P>0.05）。2组患者的术后生活质量在神经肌肉、心理、瘢痕、感觉冷方面差异有统计学意义（P值均<0.05），其他生活质量评分差异均无统计学意义（P值均>0.05）。在术后6个月美观满意度上腔镜组优于开放组，差异有统计学意义（χ2=41.47，P<0.05）。 结论： 无充气经腋窝腔镜手术是一种安全可靠的手术方式，与传统经颈部入路的甲状腺癌根治术相比，其美容效果显著，并且可在一定程度上提高患者术后的生活质量。.