经口腔前庭入路腔镜甲状腺手术15例临床分析

Preliminary experience in transoral endoscopic thyroidectomy via the vestibular approach:a clinical analysis of 15 cases

目的:总结介绍经口腔前庭入路腔镜甲状腺手术经验。方法:2018年1月—2019年12月,经口腔前庭入路腔镜甲状腺手术15例,分析其临床病理特征、围手术期处理、手术范围、手术时间及并发症。结果:15例患者均为单侧病变,其中良性肿瘤5例,最大径5cm,均行单侧甲状腺次全切除,平均手术时间(146±34)min;甲状腺微小乳头状癌10例,右侧8例,左侧2例,均行单侧甲状腺腺叶切除并同侧中央区清扫淋巴结,平均手术时间(187±36)min,平均清扫淋巴结数目(7.1±2.3)枚,淋巴结转移率为40%(4/10)。无中转手术,无术后出血及二次手术。2例术后出现颏部、口唇麻木,1例暂时性喉返神经麻痹,均自行恢复。随访时间1~22个月,未见种植、复发、转移。结论:经口腔前庭入路腔镜下甲状腺手术安全可行,术后体表无瘢痕,美容效果好。手术适应证选择、严格的术前准备和手术技巧的把握是治疗成功的关键。

Objective:To summarize the preliminary experience with transoral endoscopic thyroidectomy via vestibular approach(TOETVA)in Primary hospital.Methods:A total of 15 cases with thyroid disease underwent TOETVA from January 2018 to December 2019 at Department of Head and neck surgery,LinYi 1tumour Hospital.To analysis Clinicopathological features、perioperative management,surgical scope,surgery time,complications and short-term follow-up.Results:All the patients were females.Five cases of benign tumors were unilateral,with a maximum diameter of 5 cm.Unilateral subtotal thyroidectomy was performed,and the average operation time was (146±34) min. There were 10 cases of unilateral thyroid micropapillary carcinoma, including 8 cases of right side cancer and 2 cases of left side cancer. All patients underwent unilateral thyroid gland lobectomy and dissection of the ipsilateral central area. The average operation time was(187±36) min. The average number of dissected lymph nodes was(7.1±2.3), and the lymph node metastasis rate was 40%(4/10). There were no transit operations, no postoperative bleeding, and no secondary surgery. Two patients had temporary numbness of the palate and lips after surgery, and one patient had temporary recurrent laryngeal nerve injury . The follow-up time ranged from 1 to 22 months. No implantation, recurrence, or metastasis was seen. Conclusion: TOETVA is safe and feasible. There is no scar on the body surface, and the cosmetic effect is good. In the early stage of the operation, special attention should be paid to the grasp of surgical techniques and the selection of indications.