Clinical study on endoscopic parathyroidectomy via infraclavicular approach versus traditional open surgery for single adenoma
基于锁骨下入路的腔镜甲状旁腺切除术与传统开放术式治疗单发腺瘤的临床研究

摘要

目的 比较锁骨下入路腔镜甲状旁腺切除术与传统开放术式治疗单发甲状旁腺腺瘤的临床疗效，重点评估两种术式在微创性、功能恢复及患者满意度方面的差异。方法 采用回顾性队列研究设计，纳入江苏省江原医院2023年1月至2025年5月外科收治的40例单发甲状旁腺腺瘤患者，分为腔镜组（20例）与开放组（20例）。对比分析两组术中指标、术后恢复指标、生化指标及患者主观评价。统计学分析采用SPSS 26.0软件，计量资料以均数±标准差表示，组间比较采用独立样本t检验；计数资料以频数表示，组间比较采用χ2检验或Fisher精确检验，显著性水平设定为P<0.05。结果 腔镜组术中出血量显著低于开放组（5.0±0.0ml/9.5±5.2ml，P<0.001），术后引流量（58.5±20.1ml/72.3±24.8ml，P=0.038）与住院天数（5.1±1.2天对6.3±1.5天，P=0.007）均显著减少。患者主观评价中，腔镜组美容满意度“非常满意”比例（85%/30%，P<0.001）及颈部感觉满意度“非常满意”比例（75%/25%，P=0.002）显著优于开放组。两组术后均无声音嘶哑、出血、切口感染等并发症出现。结论 锁骨下入路腔镜手术在微创性、术后恢复速度及患者主观体验方面优势显著，尤其适用于对外观敏感的年轻患者。临床决策需结合患者个体需求、病灶复杂性及医疗资源条件，未来应进一步优化腔镜技术以缩短学习曲线并降低费用，推动微创术式的广泛应用。

Abstract

Objective To compare the clinical efficacy of endoscopic parathyroidectomy via the infraclavicular approach and traditional open surgery in the treatment of single parathyroid adenoma, focusing on evaluating the differences between the two surgical methods in terms of minimally invasiveness, functional recovery and patient satisfaction.
Methods A retrospective cohort study design was adopted. A total of 40 patients with single parathyroid adenoma admitted to the Department of Surgery of Jiangyuan Hospital of Jiangsu Province from January 2023 to May 2025 were included and divided into the endoscopic group (20 cases) and the open group (20 cases). The intraoperative indicators, postoperative recovery indicators, biochemical indicators and patients' subjective evaluation of the two groups were compared and analyzed. Statistical analysis was performed using SPSS 26.0 software. Measurement data were expressed as mean ± standard deviation, and independent sample t-test was used for comparison between groups; counting data were expressed as frequency, and χ² test or Fisher's exact test was used for comparison between groups. The significance level was set at P<0.05.
Results The intraoperative blood loss in the endoscopic group was significantly lower than that in the open group (5.0±0.0ml vs 9.5±5.2ml, P<0.001). The postoperative drainage volume (58.5±20.1ml vs 72.3±24.8ml, P=0.038) and hospital stay (5.1±1.2 days vs 6.3±1.5 days, P=0.007) in the endoscopic group were significantly reduced. In patients' subjective evaluation, the proportion of "very satisfied" with cosmetic satisfaction (85% vs 30%, P<0.001) and the proportion of "very satisfied" with neck sensation satisfaction (75% vs 25%, P=0.002) in the endoscopic group were significantly better than those in the open group. There were no complications such as hoarseness, bleeding and incision infection in both groups after operation.
Conclusion   Endoscopic surgery via the infraclavicular approach has significant advantages in minimally invasiveness, postoperative recovery speed and patients' subjective experience, and is especially suitable for young patients sensitive to appearance. Clinical decision-making should be combined with patients' individual needs, lesion complexity and medical resource conditions. In the future, endoscopic technology should be further optimized to shorten the learning curve and reduce costs, so as to promote the wide application of minimally invasive surgery.