达芬奇机器人与开放性手术在肿瘤直径大于1cm甲状腺癌中的对照研究

A comparative study of da Vinci robot and open surgery in thyroid cancer with tumor diameter greater than 1cm

目的探讨达芬奇机器人下甲状腺全切+中央区+颈侧区淋巴结清扫治疗肿瘤直径>1 cm乳头状甲状腺癌的可行性、有效性及安全性。方法回顾性分析2014年2月至2018年6月在解放军第九六〇医院甲状腺乳腺外科接受达芬奇机器人腋乳入路甲状腺全切+中央区+单侧颈侧区淋巴结清扫术的81例乳头状非微小癌患者(机器人组)的临床资料,与同期接受传统开放手术的87例乳头状非微小癌患者(开放组)进行比较。采用统计学检验比较两组的手术时间、清扫中央区和单侧颈侧区淋巴结数目、术中出血量、住院时间、术后引流量、术后美容效果及手术并发症发生率等。结果所有患者均顺利完成手术。与开放组相比,机器人组的手术时间及术后引流量多于开放组,术后美容效果更佳(P<0.05);清扫中央区和单侧颈侧区淋巴结数目、术中出血量、术后引流量、并发症发生率等方面差异无统计学意义(P>0.05)。结论对于有选择性的肿瘤直径>1 cm的乳头状甲状腺癌患者,达芬奇机器人腋乳入路与传统开放手术行甲状腺全切+中央区+单侧颈侧区淋巴结清扫治疗安全性和治疗效果相似且术后美容效果更佳。

Objective To evaluate surgical outcomes, feasibility and the effectiveness of robotic thyroidectomy and central with lateral neck dissection for treatment of papillary thyroid carcinoma with diameter larger than 1 cm. Methods The clinical data of 81 patients of papillary thyroid underwent robotic thyroidectomy and central with lateral neck dissection through axillo-bilateral breast approach in the 960th Hospital of the People′s Liberation Army of China from Feb. 2014 to Jun. 2018, compared with the 87 cases treated with traditional open surgery (open group). Statistical tests was used to compare the two groups, operating time, blood loss, postoperative drainage volume and hospital stay, visual analogue scale, cosmetic effect, the amount of lymph nodes and postoperative complications. Results All patients were diagnosed of papillary thyroid and completed the operation successfully. Compared with the open group, the operating time and postoperative drainage in the robot group were more than that in the open group, and the cosmetic effect was better (P<0.05). There were no significant differences in the number of lymph nodes dissected in the central and lateral regions, blood loss, hospital stay, postoperative drainage volume, incidence of complications, and visual analogue score of postoperative pain (P>0.05). Conclusions For patients with papillary thyroid carcinoma with tumor diameter larger than 1cm, robotic total thyroidectomy and central with lateral selective neck dissection through bilateral axillo-breast approach has similar surgery safety and feasibility as open procedures, while with better cosmetic effect.