经口腔前庭入路腔镜甲状腺腺叶联合中央区淋巴结整块切除术的临床研究

Clinical study of endoscopic thyroid gland lobe combined with central lymph node enblock resection via oral vestibular approach

目的:探讨经口腔前庭入路行腔镜甲状腺腺叶联合中央区淋巴结整块切除术的临床疗效。方法:2019年3月至2019年12月为10例甲状腺癌患者经口腔前庭入路行腔镜甲状腺腺叶联合中央区淋巴结整块切除术,分析手术时间、出血量、术后住院时间、引流量、手术并发症、疼痛评分、美容满意度评分等。结果:手术均获成功,病理诊断甲状腺微小乳头状癌;中央区淋巴结转移:2例有2枚淋巴结转移,2例有1枚转移,6例无转移。手术时间平均(120.4±26.5)min,出血量平均(15.6±6.5)mL,术后平均住院(4.5±1.5)d,引流量平均(35.3±16.2)mL,拔管时间平均(1.8±0.6)d。术后复查甲状旁腺素正常。术后无下颌、下唇麻木,口腔切口感染、声嘶、呛咳等。术后第1天疼痛评分为(3.2±0.8)分,术后1个月美容满意度评分为(9.4±0.4)分。结论:经口腔前庭入路腔镜甲状腺腺叶联合中央区淋巴结整块切除术,循间隙游离能完成整块切除,符合无瘤原则;可有效保护喉返神经、甲状旁腺,美容效果满意。

Objective:To explore the clinical effect of endoscopic thyroid gland lobe combined with central lymph node enblock resection through oral vestibular approach.Methods:From Mar.2019 to Dec.2019,10 patients with thyroid cancer underwent endoscopic enblock resection of thyroid gland lobe combined with central lymph node through oral vestibular approach,and the operative time,blood loss,postoperative hospital stay,drainage volume,surgical complications,pain score and aesthetic satisfaction score were analyzed.Results:All the patients were successfully operated and diagnosed with papillary thyroid microcarcinoma.Central lymph node metastasis:2 cases had 2 metastases,2 cases had 1 metastasis,and 6 cases had no metastasis.The mean operation time was(120.4±26.5)min,the blood loss was(15.6±6.5)mL,the postoperative hospital stay was(4.5±1.5)d,the drainage volume was(35.3±16.2)mL,and the extubation time was(1.8±0.6)d.The parathyroid hormone was normal after surgery.After the operation,there was no numbness of mandible and lower lip,infection of oral incision,hoarseness,bucking and so on.The pain score on the first day after the operation was(3.2±0.8)points,and the cosmetic satisfaction score on the first month after the operation was(9.4±0.4)points.Conclusions:Endoscopic thyroid gland lobe combined with central lymph node enblock resection through oral vestibular approach can be completed with interstitial dissociation,accords with the tumor-free principle,can effectively protect recurrent laryngeal nerve and parathyroid gland,its cosmetic effect is satisfactory.