免充气经腋窝入路腔镜手术联合柴胡散结方治疗甲状腺癌预后效果研究

doi:10.3969/j.issn.2095-378X.2026.03.003

摘要/Abstract

摘要： 目的分析免充气经腋窝入路腔镜手术联合柴胡散结方治疗甲状腺癌预后效果。方法选取2023年4月—2025年3月接受腔镜手术治疗的95例甲状腺癌患者（经1︰1倾向性评分匹配后纳入的病例）,根据患者意愿选择的术式和术后辅助治疗方式的不同,将患者分为A组（经乳晕入路充气腔镜手术+西医治疗,31例）、B组（免充气经腋窝入路腔镜手术+西医治疗,30例）、C组（免充气经腋窝入路腔镜手术+西医治疗+柴胡散结方治疗,35例）。结果三组的各项术后恢复情况指标均呈现统计学差异（P<0.05）;其中B组与C组的术后首次进食时间、术后首次下床活动时间、引流管拔除时间、声音嘶哑持续时间、饮水呛咳持续时间、住院时间均短于A组（P<0.05）;C组的引流管拔除时间、声音嘶哑持续时间、饮水呛咳持续时间、住院时间均短于B组（P<0.05）,其余指标均未呈现统计学差异（P>0.05）。B组与C组的术后并发症发生率低于A组（P<0.05）,而B组与C组之间无统计学差异（P>0.05）。三组术后6、24、48、72 h的疼痛视觉模拟评分均呈现统计学差异（P<0.05）,其中B组、C组的分值低于A组（P<0.05）,C组的分值低于B组（P<0.05）。三组术前的C-反应蛋白、白细胞介素-6、甲状腺球蛋白、甲状腺球蛋白抗体、甲状腺过氧化物酶抗体水平均无统计学差异（P>0.05）,术后3 d、术后7 d、术后1个月,三组的各项炎症指标水平均呈下降趋势,B组与C组均低于A组（P<0.05）,C组低于B组（P<0.05）。三组的无进展生存和总生存情况均未无统计学差异（P>0.05）。结论针对甲状腺癌患者采取免充气经腋窝入路腔镜手术相比于常规经乳晕入路充气腔镜手术能减轻手术创伤程度及炎性刺激、减少并发症、减轻疼痛程度,能获得相当的预后效果;联合柴胡散结方治疗不影响肿瘤根治的预后效果,并且可进一步减轻炎症反应、疼痛程度,加快术后康复进程。

关键词: 免充气经腋窝入路腔镜手术, 柴胡散结方, 甲状腺癌, 预后效果

Abstract: Objective To investigate the prognostic effect of gasless transaxillary endoscopic surgery combined with Chaihu Sanjie Formula on thyroid cancer. Methods A total of 95 patients with thyroid cancer who received endoscopic surgery from April 2023 to March 2025 were selected after 1∶1 propensity score matching. According to the different surgical methods and postoperative adjuvant treatments, the patients were divided into Group A （gas-insufflation endoscopic surgery via areola + Western medicine treatment, 31 cases）, Group B （gasless transaxillary endoscopic surgery + Western medicine treatment, 30 cases）, and Group C （gasless transaxillary endoscopic surgery + Western medicine treatment + Chaihu Sanjie Formula treatment, 35 cases）. Results All postoperative recovery indicators in the three groups showed statistical differences （P<0.05）; the time to first postoperative meal, the time to first postoperative ambulation, the time to drainage tube removal, the duration of hoarseness, the duration of drinking water cough, and the length of hospital stay were shorter in Group B and Group C than in Group A （P<0.05）; the time to drainage tube removal, the duration of hoarseness, the duration of drinking water cough, and the length of hospital stay were shorter in Group C than in Group B （P<0.05）, while the remaining indicators showed no statistical differences （P>0.05）. The postoperative complication rates in Group B and Group C were lower than that in Group A （P<0.05）, while there was no statistical difference between Group B and Group C （P>0.05）. The visual analogue scale pain scores at 6 h, 24 h, 48 h and 72 h after operation in the three groups showed statistical differences （P<0.05）, in which the scores of Group B and Group C were lower than those of Group A （P<0.05）, and the score of Group C was lower than that of Group B （P<0.05）. The levels of C-reactive protein, interleukin-6, thyroglobulin, thyroglobulin antibody, and thyroid peroxidase antibody in the three groups before operation showed no statistical difference （P>0.05）. The levels of inflammatory indicators in the three groups showed a downward trend at 3 d, 7 d, and 1 month after operation. The levels of inflammatory indicators in Group B and Group C were lower than those in Group A （P<0.05）, and those in Group C were lower than those in Group B （P<0.05）. There were no statistical differences in progression-free survival and overall survival among the three groups （P>0.05）. Conclusion Compared with conventional gas-insufflation endoscopic surgery via areola, gasless transaxillary endoscopic surgery for thyroid cancer patients can reduce surgical trauma and inflammatory stimulation, decrease complications, relieve pain, and achieve comparable prognostic effects; combined treatment with Chaihu Sanjie Formula does not affect the prognostic effect of tumor radical resection, but can further reduce inflammatory response and the degree of pain, accelerating postoperative recovery.

Key words: Gasless transaxillary endoscopic surgery, Chaihu Sanjie Formula, Thyroid cancer, Prognostic effect

中图分类号:

R653

陈喆, 王永恒. 免充气经腋窝入路腔镜手术联合柴胡散结方治疗甲状腺癌预后效果研究[J]. 外科研究与新技术（中英文）, 2026, 15(3): 207-213.

CHEN Zhe, WANG Yongheng. Prognostic effect of gasless transaxillary endoscopic surgery combined with Chaihu Sanjie Formula on thyroid cancer[J]. Surgical Research and New Technique, 2026, 15(3): 207-213.

参考文献

[1] 张芷悦,何慧婧,单广良,等.甲状腺癌的流行病学现状及其影响因素研究进展[J].中国癌症杂志,2025,35(1):21-29.
[2] 王小贝,吕庆福,倪婷.免充气腋窝入路与全乳晕入路腔镜下甲状腺癌根治术的临床对比[J].中华普外科手术学杂志(电子版),2025,19(4):368-371.
[3] 乐飞,薛会朝.经腋窝入路免充气腔镜下行甲状腺癌根治术的疗效及安全性评价[J].实用癌症杂志,2021,36(12):1967-1969.
[4] 徐子缘,朱垚,陆明,等.国医大师周仲瑛辨治甲状腺癌医案集内关联解析研究[J].数字中医药(英文版),2022,5(2):141-153.
[5] 中国临床肿瘤学会指南工作委员会.中国临床肿瘤学会(CSCO)分化型甲状腺癌诊疗指南2021[J].肿瘤预防与治疗,2021,34(12):1164-1200.
[6] 瘿瘤的诊断依据、证候分类、疗效评定——中华人民共和国中医药行业标准《中医内科病证诊断疗效标准》(ZY/T001.1-94)[J].辽宁中医药大学学报,2018,20(10):140.
[7] 黄卫荣,陈晓东,李恩惠.经腋窝入路无充气腔镜下手术对早期甲状腺肿瘤患者免疫功能及美容效果的影响[J].中国内镜杂志,2023,29(2):35-40.
[8] 陈晋,周敏露,郑宇,等.腔镜经腋窝入路免充气单侧甲状腺癌根治术的疗效研究[J].腹腔镜外科杂志,2024,29(8):569-573.
[9] 林才云,王炜.柴胡疏肝散加减治疗甲状腺癌术后肝郁气滞证的临床研究[J].广州中医药大学学报,2023,40(10):2486-2491.
[10] 江春容,李振华,张卫卫,等.无充气腋窝入路腔镜甲状腺手术治疗甲状腺癌临床疗效的Meta分析[J].腹腔镜外科杂志,2023,28(12):881-888.
[11] Lin L, Chen S, Lu Y.Comparison between gas insufflation and gasless techniques for endoscopic transaxillary thyroidectomy[J]. Front Endocrinol (Lausanne), 2024, 31(15): 1434419.
[12] 任国英,李宁,张玲染,等.免充气经腋窝入路腔镜手术治疗良性甲状腺结节的效果及安全性[J].临床误诊误治,2026,39(6):89-93.
[13] Lee MC, Ahn J, Choi IJ, et al.Comparative study of gasless transaxillary, bilateral axillo-breast, unilateral axillo-breast with carbon dioxide insufflation, retroauricular, and transoral vestibular endoscopic thyroidectomy approaches at a single institution: a retrospective analysis and lessons learned[J]. Clin Exp Otorhinolaryngol, 2022, 15(3): 283-291.
[14] 吴文彩,李军,陈煜婵.柴胡散结方联合穴位贴敷治疗气郁痰阻型甲状腺良性结节的临床观察[J].中医药临床杂志,2025,37(10):2117-2121.
[15] 王泽,林兰,刘兵.基于数据挖掘的林兰教授治疗甲状腺结节用药经验研究[J].现代中西医结合杂志,2024,33(8):1111-1115.
[16] 杨泽红,刘铜华,潘雅婧,等.基于数据挖掘分析刘铜华治疗甲状腺结节的用药规律[J].国际中医中药杂志,2026,48(4):455-459.
[17] 朱恒舟,季漪,马艳霞,等.基于网络药理学试述消癌解毒方组方中君臣关系及其防治肝癌的研究[J].世界科学技术-中医药现代化,2019,21(11):2356-2366.
[18] Jasaitis K, Midlenko A, Bekenova A, et al.Transaxillary gasless endoscopic thyroidectomy versus conventional open thyroidectomy: systematic review and meta-analysis[J]. Wideochir Inne Tech Maloinwazyjne, 2021, 16(3): 482-490.