双侧腋窝乳晕入路达芬奇机器人甲状腺手术并发症特征分析

Complications of Da Vinci robot thyroid surgery by bilateral axillo-breast approach

目的探讨双侧腋窝乳晕入路(bilateral axillo-breast approach,BABA)达芬奇机器人甲状腺手术并发症的特点。方法回顾性分析解放军第九六〇医院2014年2月至2020年3月收治的1198例经BABA行达芬奇机器人甲状腺手术患者的病例资料,其中男263例,女935例,年龄9~68岁。良性病变288例,恶性肿瘤910例。根据术前影像学检查、细针穿刺细胞学检查(FNAC)和术中冰冻病理选择术式,总结并发症的发生情况。结果随访3个月~1年,187例(15.61%)患者出现并发症,手术并发症如下:暂时性喉返神经损伤10例(0.83%),永久性喉返神经损伤1例(0.08%),暂时性甲状旁腺功能减退152例(12.69%),无永久性甲状旁腺功能减退患者,舌下神经损伤1例(0.08%),面神经下颌缘支损伤2例(0.17%),气管损伤2例(0.17%),无食管损伤,乳糜漏5例(0.42%),颈部术区皮肤粘连错位3例(0.25%),皮下出血2例(0.17%),皮肤灼伤2例(0.17%),血清肿5例(0.42%),颈总动脉破裂1例(0.08%),颈内静脉破裂1例(0.08%),无肿瘤种植,无臂丛神经、副神经和膈神经损伤。结论BABA达芬奇机器人甲状腺手术并发症少,是安全的术式。

Objective To evaluate the complications of Da Vinci robotic thyroid surgery by bilateral axillo-breast approach.Methods A retrospective analysis of complications was conducted on 1,198 cases of Da Vinci robotic thyroid surgery by bilateral axillo-breast approach of the 960 th Hospital of the People's Liberation Army from February 2014 to March 2020.There were 263 men and 935 women,age ranged from 9 to 68 years old,and included 288 benign lesions and 910 malignancies according to preoperative imaging examination,FNAC,and intraoperative frozen pathology.Results Surgical complications occurred in 187(15.61%)patients,including 10 cases of temporary larynx nerve injury(0.83%),1 case of permanent larynx nerve injury(0.08%),and 152 cases of temporary hypoparathyroidism(12.69%),no permanent hypoparathyroidism,1 case of hypoglossal injury(0.08%),2 cases of facial nerve jaw branch damage(0.17%),2 cases of trachea injury(0.17%),no esophagus damage,5 cases of celiac leakage(0.42%),3 cases of neck skin adhesion(0.25%),2 cases of subdermal bleeding(0.17%),2 cases of skin burns(0.17%),5 cases of hematoma(0.42%),1 case of cephalic artery rupture(0.08%),1 case of jugular vein rupture(0.08%),no tumor cultivation,no arm plex nerve,accessory nerve or phrenic nerve damage.Conclusion Da Vinci robot thyroid surgery by bilateral axillo-breast approach is safe,with less severe complications.