经胸锁乳突肌肌间入路行单侧甲状腺癌根治术的临床价值

The feasibility and safety of sternocleidomastoid intermuscular approach in unilateral radical thyroidectomy

摘要:

目的 探究经胸锁乳突肌肌间入路（sternocleidomastoid intermuscular approach, SMIA）行单侧甲状腺癌根治术的可行性和安全性。方法 回顾性分析2021年1月—2022年8月在同济大学附属东方医院收治的80例单侧甲状腺癌患者；其中观察组行SMIA手术（40例）,对照组行经常规颈白线入路手术（40例）。比较两组患者基本情况、术中观察指标、术后恢复情况。结果 两组患者在年龄、性别、癌灶直径、手术时间、术中出血量、中央组淋巴结清扫数目、术后甲状旁腺激素水平、术后引流量以及术后并发症方面差异均无统计学意义（P>0.05）。两组患者在切口隐蔽满意度、颈部麻木牵拉感、Vancouver瘢痕评定量表评分结果有明显差异（P<0.05）。结论 与常规经颈白线入路相比，SMIA行单侧甲状腺癌根治术，在不影响手术效果的前提下，患者切口位置更加隐蔽、术后颈部麻木牵拉感更轻，切口更加美观，是安全可行、值得临床推广的一种手术方式。

Abstract:

Objective To evaluate the efficacy and safety of sternocleidomastoid intermuscular approach(SMIA) in unilateral radical thyroidectomy. Methods Clinical data of 80 patients who underwent unilateral radical thyroidectomy in East Hospital, Tongji University School of Medicine from January 2021 to August 2022 were analyzed retrospectively, including 40 cases with SMIA(SMIA group) and 40 cases with conventional linea alba cervicalis approach(control group). The basic information, intraoperative indicators and postoperative outcomes were compared between two groups. Results There was no significant differences in the age, sex, tumor size, operation time, intraoperative blood loss, number of central lymph node compartment dissection, postoperative PTH level, postoperative drainage volume and incidence of complications between the two groups(P>0.05). The satisfaction of incision concealment was better, cervical numbness and traction was less, and the score of Vancouver Scar Scale(VSS) was lower in SMIA group than those in the control group(P<0.05). Conclusion Compared with the linea alba cervicalis approach, radical thyroidectomy through SMIA has similar surgery effect, but has more hidden incision, less postoperative cervical traction discomfort and better aesthetics, indicating that SMIA is safe and feasible for clinical application.