经口腔前庭入路腔镜甲状腺手术150例临床分析

Preliminary experience with transoral endoscopic thyroidectomy via vestibular approach： a report of 150 cases in a single center

目的 探讨经口腔前庭入路腔镜甲状腺手术的初步经验.方法 回顾性分析2014年11月至2017年2月共150例在浙江大学医学院附属第二医院甲状腺外科接受经口腔前庭入路腔镜甲状腺手术的病例资料.男性12例,女性138例;平均年龄（31.7±7.6）岁.分化型甲状腺癌（T1或T2≤3 cm、cN0或cN1a、M0）108例,良性病变（实性结节最大径≤6 cm）42例.总结患者的临床病理特征、手术方式、手术时间、并发症及随访情况.结果 2例患者分别因术中发现肿瘤体积太大和肿瘤侵犯气管而中转开放手术.103例行经口中央区淋巴结清扫;其中85例行甲状腺腺叶切除加中央区淋巴结清扫术,平均手术时间（146±34）min;18例行甲状腺全或近全切除加中央区淋巴结清扫术,平均手术时间（187±36）min.平均清扫淋巴结数目（8.2±4.7）枚,淋巴结转移率为41.7％ （43/103）.术后发生暂时性喉返神经损伤3例,永久性喉返神经损伤2例,颈部感染1例,颏神经暂时性麻痹1例;行甲状腺全切除、近全切除和次全切除术的22例患者中,7例（31.8％）发生暂时性低钙血症,无永久性低钙血症发生.术后平均住院时间（3.5±0.6）d,随访时间1 ～ 28个月,无复发或转移.结论 对于严格选择的病例,经口腔前庭入路甲状腺手术安全可行,具备良好的美容效果,远期疗效有待进一步观察.

Objective To summarize the preliminary experience with transoral endoscopic thyroidectomy via vestibular approach （TOETVA）.Methods A total of 150 consecutive patients with thyroid disease underwent TOETVA from November 2014 to February 2017 at Department of Thyroid Surgery,the Second Affiliated Hospital of Zhejiang University School of Medicine.The patients were comprised of 138 females and 12 males.The mean age of the patients was （31.7±7.6） years （ranging from 15 to 51 years）.There were 108 patients of differential thyroid carcinoma （T1 or T2 ≤3 cm,cN0 or cN1a,M0） and 42 patients of benign thyroid disease （solid nodule ≤ 6 cm）.The criteria analyzed were clinicopathologic characteristics,types of operation,operation time,complications and results of follow-up.Results Two cases were converted into open surgery due to an incredible unexpected tumor size and tracheal invasion,respectively.One hundred and three patients with papillary carcinoma underwent transoral central neck dissection （CND）,with the mean operation time of （146±34） minutes for hemithyroidectomy with CND,and （187±36） minutes for total or near total thyroidectomy with CND.The mean number of lymph node yields was 8.2±4.7,and the lymph node metastasis rate was 41.7% （43/103）.Regarding postoperative complications,transient hoarseness occurred in 3 patients,and permanent recurrent laryngeal nerve occurred in 2 patients.One patient had local infection or transient mental nerve palsy.Transient hypocalcemia occurred in 31.8% of 22 patients who underwent total,near-total,or subtotalthyroidectomy,and no permanent hypocalcemia was registered.Mean hospital stay after operation was （3.5± 0.6） days （ranging from 2 to 5 days）.Mean follow-up period was （11.5 ± 7.8） months （ranging from 1 to 28 months）,no recurrence or metastasis occurred.Conclusions TOETVA is feasible and safe for strictly selective patients.It brings perfect cosmetic effect.Long-term follow-up and further study is needed to assess its curative effect.