经口腔前庭入路腔镜甲状腺手术在甲状腺乳头状癌中的安全效用分析

The safety and feasibility of transoral endoscopic thyroidectomy vestibular approach(TOETVA)in papillary thyroid cancer

目的探究经口腔前庭入路腔镜甲状腺手术在甲状腺乳头状癌中的安全性及效用。方法回顾性分析2017年06月~2020年01月期间青岛大学附属烟台毓璜顶医院行经口腔镜甲状腺手术患者146例,将139例PTC患者纳入研究,总结建腔经验、术后视觉疼痛评分、住院时间、清扫淋巴结数目、并发症及术后随访情况。结果完成经口腔前庭入路单侧甲状腺癌手术135例,平均手术时间(132±34.9)min;经口腔前庭入路双侧甲状腺癌4例,平均手术时间(168±38.5)min。平均中央区淋巴结清扫数目(7.1±4.6)枚,中央区淋巴结转移率47.5%(66/139),术后平均住院天数(1.9±0.7)d。暂时性喉返神经损伤率1.4%,暂时性甲状旁腺功能低下为0.7%。颏神经损伤7例(5.0%),暂时性下唇运动功能障碍9例,暂时性面神经下颌缘支分损伤2例。结论经口腔镜前庭入路腔镜手术可以进行标准的加速康复外科理念管理,在单侧甲状腺乳头状癌中具有良好的肿瘤治疗效果及手术安全性。

Objective To explore the safety and efficiency of transoral endoscopic thyroidectomy vestibular approach(TOETVA)in papillary thyroid cancer(PTC).Methods This study retrospectively reviewed 146 patients who underwent TOETVA between June 2017 and January 2020 at the Affiliated Yantai Yuhuangding Hospital of Qingdao University.Of those,139 patients with pathologically confirmed PTC were enrolled in this study.Analyses were performed of the workflow experience,visual pain score on the first postoperative day,length of hospital stay,number of central neck lymph nodes removed,complications,and results of follow-ups.Results A total of 135 cases required hemithyroidectomy plus isthmectomy and central neck dissection(CND)with a mean operation time of 132±34.9 min;4 cases required total thyroidectomy and CND with a mean operation time of 168±38.5 min.The mean number of central neck lymph nodes removed was 7.1±4.6 and the metastasis rate was 47.5%(66/139).Postoperative hospital stay was 1.9±0.7 days.Regarding postoperative complications,the incidence of transient recurrent laryngeal nerve injury(RLN)and transient hypoparathyroidism was 1.4%(2/139)and 0.7%(1/139),respectively.No permanent RLN injury and hypoparathyroidism occurred.Mental nerve injury occurred in 5.0%(7/139).Transient abnormal motor function of the lower lip and marginal mandibular branches of the facial nerve was observed in nine cases and two cases,respectively.Conclusion TOETVA can be performed by standard workflow with the principle of enhanced recovery after surgery(ERAS).TOETVA is feasible in selected PTC patients for its cosmetical results and oncological safety.