达芬奇机器人行甲状腺癌颈侧区清扫的临床研究

Clinical study of robotic lateral neck dissection by bilateral axillo-breast approach for differentiated thyroid carcinoma

目的评估达芬奇机器人双侧腋窝和乳晕径路(BABA)对低危伴颈侧区淋巴结转移分化型甲状腺癌行甲状腺全切+中央区淋巴结清扫+颈侧区淋巴结清扫的外科安全性和可行性。方法分析2014年8月至2015年2月在济南军区总医院采用BABA完成甲状腺全切+中央区淋巴结及颈侧区淋巴结清扫的12例患者临床资料。结果所有患者均接受机器人甲状腺手术,达芬奇机器人颈侧区清扫时间平均(74±12)min,其中8例患者出现术后短暂性甲状旁腺功能减退,术后2周均恢复正常,无喉返神经损伤发生及乳糜漏发生,短期随访未发现颈部可疑淋巴结残留及淋巴结复发。患者对切口满意。结论对低危伴颈侧区淋巴结转移甲状腺癌行BABA甲状腺全切+中央区淋巴结清扫+颈侧区淋巴结清扫是可行的,并取得较好美容效果,同时相较于传统开放性手术其手术的安全性及彻底性还需要进一步临床研究证实。

Objective The aim of this study was to determine the technical feasibility and intraoperative safety of robotic total thyroidectomy and central with lateral selective neck dissection by bilateral axillo-breast approach in lowrisk differentiated thyroid carcinoma （DTC） with their lateral neck lymph node metastasis. Methods We analyzed 12 patients with DTC who underwent robotic total thyroidectomy and central with lateral selective neck dissection by bilateral axillo-breast approach in Aug. 2014 to Feb. 2015 in Jinan Military General Hosptial. Results The procedure was completed successfully in all patients. The mean console time for robotic lateral neck dissection was （74 ± 12 ） minutes in 12 patients, transient hypoparathyroidism occurred in 8 patients, after two weeks were back to normal, no transient recurrent laryngeal nerve palsy and no chyle leak occurred, and shortterm follow-up did not find the suspicious neck lymph nodes residual and lymph nodes recurrence. Cosmetic satisfaction was excellent in all patients. Conclusions Robotic total thyroidectomy and central with lateral selective neck dissection by bilateral axillobreast approach in lowrisk DTC is feasible and allows for excellent postoperative cosmesis in preliminary results. Further studies are needed to establish oncologie safety and surgical completeness compared with conventional neck dissection.