Abstract: Effects of surgical technique with non-inflatable endoscopic thyroidectomy through unilateral axillary approach and its relation factors        SHI Chen-lei, HOU Chao-yue, SHI Tie-feng, et al. The Second Affiliated Hospital, Harbin Medical University, Harbin 150086, China
Corresponding author: SHI Tie-feng, E-mail：457614014@qq.com
Abstract    Objective    To investigate the clinicopathological characteristics of thyroidectomy used non-inflatable endoscopic through axilla with the increase of the number of operations, and to study the correlation between BMI and the effect of endoscopic surgery. Methods    The clinical data of 99 cases of thyroidectomy used non-inflatable endoscopic through unilateral axilla (endoscopic group) and 72 cases of unilateral open thyroidectomy (open group) treated in the thyroid surgery Department of the Second Affiliated Hospital of Harbin Medical University from October 2020 to August 2021 were analyzed retrospectively. According to the operation time and the number of lymph node dissections, the exploration curve of surgical technology in endoscopic group was drawn, the technology periods of exploration and maturity were divided, and the differences of clinicopathological data between the endoscopic group in technical mature stage and the open group were compared. The two groups were divided into two sub-groups (BMI＞28 and BMI≤28). The relationship among BMI and clinicopathological data in the technical mature stage in endoscopic group ，and the open group was explored. Results    The age of patients in the endoscopic group was significantly lower than that in the open group ［(37.1 ± 9.2 years) vs. (44.3 ± 9.3 years), P<0.01］. According to the technical exploration curve, there were 26 cases in the technical exploration stage and 73 cases in the technical maturity stage in the endoscopic group. The operation time (102.5±21.4 min), postoperative drainage volume (133.6±40.7 ml) and postoperative hospital stay (3.9 ± 0.6 d) in the technical maturity stage in the endoscopic group were significantly longer than those in the open group ［the operation time (67.7 ± 14.0 min), drainage volume (67.3 ± 25.7 ml) and postoperative hospital stay (3.1 ± 0.4 d), P< 0.01］. One month after operation, the incision satisfaction in the technical maturity stage in endoscopic group was significantly higher than that in the open group (100.0% vs. 66.7%, P<0.05). Compared with the two BMI subgroups of patients in the open group, the operation time, total drainage volume and postoperative hospital stay of those in the technology mature stage in the endoscopic group were significantly increased (P<0.05). Conclusion    The thyroidectomy used non-inflatable endoscopic through axilla is a safe method, and it is easy to be accepted by young patients with more satisfaction. BMI is not an influencing factor to increase the difficulty of endoscopic surgery.

Key words: thyroid cancer, endoscopy, axillary approach, body mass index

摘要： 目的    探讨经腋窝无充气腔镜甲状腺癌根治术的临床病理数据伴随开展手术例数增加的变化特征并研究BMI与腔镜手术开展效果的相关性。方法    回顾性分析2020年10月至2021年8月哈尔滨医科大学附属第二医院甲状腺外科收治的单侧无充气经腋窝腔镜甲状腺癌根治术（腔镜组）99例与单侧开放甲状腺癌根治术（开放组）72例病人临床资料。依据手术时间及淋巴结清扫数量绘制腔镜组手术技术探索曲线，划分技术探索期和技术成熟期，并比较技术成熟期腔镜组病例与开放组病例临床病理数据的差异。进一步将病例分为BMI＞28和BMI≤28亚组，探讨BMI与技术成熟期腔镜手术及开放手术各临床病理数据的关系。结果    腔镜组病人年龄低于开放组，差异有统计学意义［（37.1±9.2）岁vs.（44.3±9.3）岁，P＜0.05］。根据技术探索曲线，腔镜组技术探索期为26例，技术成熟期为73例。技术成熟期腔镜组病人的手术时间（102.5±21.4）min、术后引流量（133.6±
40.7）mL和术后住院时间（3.9±0.6）d明显多于开放组［手术时间67.7±14.0）min、引流量（67.3±25.7）mL、术后住院时间（3.1±0.4）d］，差异有统计学意义（P＜0.01）。技术成熟期腔镜组病人术后1个月切口满意度明显高于对照组（100.0% vs. 66.7%），差异有统计学意义（P＜0.05）。与开放组的不同BMI亚组病人相比，技术成熟期行腔镜手术的不同BMI亚组病人的手术时间、总引流量、术后住院时间均明显增加（P＜0.05）。结论    无充气经腋窝腔镜甲状腺癌根治术是一种更加被年轻病人接受的安全且美容满意度高的手术方式，BMI并不是增加腔镜手术开展难度的影响因素。

关键词: 甲状腺癌, 腔镜, 腋窝入路, 体重指数