目的:评估经腋窝入路无充气单孔内镜手术(TAWISES)和常规开放颈前入路(COACAS)手术的卫生技术。
方法:回顾性分析2021年01月至2022年12月期间我院收治的60例单侧甲状腺癌根治术患者的临床资料。对照组行COACAS(30例),实验组接受TAWISES(30例)。患者手术时间,术中出血量,术后24h疼痛指数,引流管携带时间,对两组患者的住院时间和并发症发生率进行比较分析。术后随访3、6、12个月,根据患者麻木情况进行评估,肌肉紧绷,颈部疼痛和其他不适,以及对社会适应和美容切口的满意度。评估两组患者1年的复发状况。进行问卷调查以评估患者对两种手术方法的接受程度。综合评价了我区不同方法的经济特征(成本效益和成本效用)。
结果:切口的长度,试验组引流管携带时间和住院时间均大于对照组(P<0.05)。并发症发生率的差异,术中出血量,两组术后24h疼痛指数及复发率比较差异无统计学意义(P>0.05)。对照组颈部不适更大,术后3个月随访,差异有统计学意义(P<0.05)。术后6个月和12个月随访时差异无统计学意义(P>0.05)。然而,轻度不适明显多见于实验组(63.33%>36.67%,80%>53.33%,P<0.05)。实验组具有较好的社会适应能力,总医疗费用更高,患者总体医疗满意度优于对照组(P<0.05)。TAWISL的接受度大于COACAS(P<0.05)。
结论:与COACLAS相比,TAWISES是安全有效的,更好地满足化妆品,患者的心理和社会适应需求。TAWISES也更具成本效益,可以更好地用于我们地区的人口,填补了我们地区甲状腺癌手术方式的空白。
OBJECTIVE: To evaluate sanitary techniques for radical thyroid cancer surgery via the transaxillary approach without inflation single-port endoscopic surgery (TAWISES) and the conventional open anterior cervical approach (COACAS) in a controlled manner.
METHODS: This work was a retrospective analysis of the clinical data of 60 patients admitted to our hospital for unilateral radical thyroid cancer surgery between 01/2021 and 12/2022. The control group underwent COACAS (30 patients), and the experimental group underwent TAWISES (30 patients). The patients\' operative time, intraoperative bleeding volume, 24-h postoperative pain index, drainage tube carrying time, hospitalization duration and complication rate were compared and analyzed. The patients were followed up for 3, 6 and 12 months postoperatively and evaluated based on numbness, muscular tightness, pain and other discomfort in the neck, as well as satisfaction with social adaptation and cosmetic incisions. The recurrence status was assessed for 1 year in both groups of patients. A questionnaire survey was conducted to assess patient acceptance of the two surgical approaches. The economic characteristics (cost-effectiveness and cost-utility) of the different approaches in our region were evaluated comprehensively.
RESULTS: The length of the incision, drainage tube carrying time and hospitalization duration were greater in the experimental group than in the control group (P < 0.05). The differences in complication rate, intraoperative bleeding volume, 24-h postoperative pain index and recurrence rate were not statistically significant between the two groups (P > 0.05). Neck discomfort was greater in the control group, and the difference was statistically significant at the 3-month postoperative follow-up (P < 0.05). The differences at the 6- and 12-month postoperative follow-ups were not statistically significant (P > 0.05). However, mild discomfort was significantly more common in the experimental group (63.33% > 36.67%, 80% > 53.33%, P < 0.05). The experimental group had better social adaptability, greater total medical costs, and better overall patient medical satisfaction than did the control group (P < 0.05). The acceptance of TAWISL was greater than that of COACAS (P < 0.05).
CONCLUSIONS: Compared with COACLAS, TAWISES is safe and effective and better meets the cosmetic, psychological and social adaptation needs of patients. TAWISES is also more cost effective and can be better utilized for the population in our region, filling the gap in surgical modalities for thyroid cancer in in our region.