经口腔前庭机器人甲状腺癌择区性颈淋巴结清扫的初步探讨

Selective cervical lymph node dissection of thyroid cancer by transoral robotic: a preliminary discussion

目的探讨经口腔前庭入路达芬奇机器人甲状腺癌择区性颈淋巴结清扫术的可行性、安全性。方法回顾性分析2020年12月至2021年8月,解放军第九六〇医院甲状腺乳腺外科收治的7例经口腔前庭入路机器人甲状腺癌择区性颈淋巴结清扫术患者的临床资料,统计7例患者的手术时间、术后住院时间、术后引流量、淋巴结清扫数、切口美容效果满意度及手术并发症等情况。通过门诊、电话、微信等方式对患者进行随访。结果7例患者均顺利完成手术,无中转开放手术,其中4例行甲状腺全切、3例行腺叶及峡部切除;6例行Ⅵ、Ⅲ、Ⅳ区清扫,1例行Ⅵ、Ⅲ、Ⅳ、Ⅴb区清扫。平均手术时间(166.857±10.134)min,平均术后住院时间(6.429±1.178)d,平均术后引流量(246.857±92.047)ml,平均侧区淋巴结清扫数(12.286±5.336)枚。无淋巴漏患者。2例患者出现暂时性甲状旁腺功能减退,无暂时性喉返神经损伤,所有患者均无永久性喉返神经损伤、永久性甲状旁腺功能减退发生,平均随访时间(9.571±1.989)个月,无复发患者。结论经口腔前庭入路机器人甲状腺癌择区性颈淋巴结清扫术安全、可行,给有特殊需求的患者提供了新的选择。

Objective To investigate the feasibility and safety of transoral robotic selective lateral cervical lymph node dissection for thyroid cancer.Methods A retrospective analysis was performed on the clinical data of 7 patients who underwent selective cervical lymph node dissection via transoral approach for thyroid cancer treated in department of Thyroid and Breast Surgery, 960 Hospital of PLA from Dec. 2020 to Aug. 2021. The operation time, postoperative hospital stay, postoperative drainage fluid volume, lymph node dissection number, cosmetic effect satisfaction and surgical complications of 7 patients were analyzed. Patients were followed up through outpatient service, telephone, wechat, etc.Results All the 7 patients completed the operation successfully without transferring to open surgery. Among them, 4 cases underwent total thyroid resection, 3 cases underwent lobes and isthmus resection, 6 cases underwent level Ⅵ, Ⅲ, Ⅵ dissection, and 1 case performed level Ⅵ, Ⅲ, Ⅵ, Ⅴb dissection. The mean operation time was (166.857±10.134) min, the mean postoperative hospital stay was (6.429±1.178) d, the mean postoperative drainage volume was (246.857±92.047) ml, and the mean number of lateral lymph nodes was (12.286±5.336). Two patients presented with temporary hypoparathyroidism without temporary recurrent laryngeal nerve injury, and no patients had permanent recurrent laryngeal nerve injury or permanent hypoparathyroidism. All patients without lymphatic leakage. Average follow-up (9.571±1.989)months, no relapse patients.Conclusions Selective cervical lymph node dissection for thyroid cancer is safe and feasible by transoral robotic, providing a new option for patients with special needs.