腋乳入路达芬奇机器人甲状腺手术的临床应用研究

Clinical application of robotic thyroid surgery via bilateral axillo-breast approach

目的:探讨腋乳入路达芬奇机器人手术治疗甲状腺乳头状癌的临床效果和优势。方法:回顾性分析2017年11月至2020年3月天津医科大学肿瘤医院行甲状腺手术的338例甲状腺乳头状癌患者的临床资料,其中153例患者接受机器人甲状腺手术(机器人组),185例患者接受传统开放甲状腺手术(开放组)。应用移动平均线法绘制机器人组的学习曲线,分为学习期和平台期,并比较平台期机器人组与开放组的手术效果、并发症发生率及术后切口美容效果的差异。结果:机器人组患者平均年龄(34.7±8.3)岁,开放组患者平均年龄(37.0±8.4)岁,差异具有统计学意义(P<0.05)。在完成16例机器人甲状腺手术后,机器人组的手术时间明显缩短并趋于平稳。平台期机器人组的手术时间、术后引流量多于开放组,差异具有统计学意义(P<0.05)。两组术中出血量、术后引流时间、术后住院时长、中央区淋巴结清扫的总数目和转移数目的差异均无统计学意义(P>0.05)。平台期机器人组术后C-反应蛋白水平显著高于开放组,差异具有统计学意义(P<0.05)。平台期机器人组术后第1天切口疼痛视觉模拟评分低于开放组(P<0.05)。两组术后喉返神经损伤、甲状旁腺功能减退的发生率相近(P>0.05)。在全甲状腺切除术后1个月,两组甲状腺球蛋白水平的差异无统计学意义(P>0.05)。机器人组术后切口美观度的数字评分系统分值高于开放组,差异具有统计学意义(P<0.001)。结论:腋乳入路达芬奇机器人甲状腺手术治疗甲状腺乳头状癌安全可行,手术效果与传统开放手术相当,术后美容效果突出。

Objective:To investigate the clinical efficacy and advantages of robotic thyroidectomy(RT)via the bilateral axillo-breast approach(BABA)in the treatment of papillary thyroid carcinoma(PTC).Methods:The clinical data of 338 patients with PTC who underwent thyroid surgery in Tianjin Medical University Cancer Institute and Hospital from November 2017 to March 2020 were retrospectively analyzed.In total,153 patients underwent RT(robotic group),while the remaining patients underwent conventional open thyroidectomy(COT;open group).The learning curve in the robotic group was drawn using the moving average method;the learning curve was divided into the learning stage and platform stage.The differences in surgical efficacy,complication rates,and postoperative cosmetic outcomes of incisions were compared between the robotic group(in the platform period)and the open group.Results:The mean age was significantly lower in the robotic group than in the open group(P<0.05).After the completion of 16 RTs,the operation time in the robotic group was significantly shortened and stabilized.The operation time was significantly longer and postoperative drainage volume was significantly higher in the platform period in the robotic group than in the open group(P<0.05).There were no significant differences between the two groups in terms of intraoperative blood loss,postoperative drainage time,postoperative hospital stay,and the number of dissected central lymph nodes and metastatic lymph nodes(P>0.05).Postoperative C-reactive protein(CRP)levels were significantly higher in the robotic group than in the open group(P<0.05).The visual analogue scale score(VAS)for incision pain on the first postoperative day were lower in the robotic group than in the open group(P<0.001).The incidence of recurrent laryngeal nerve injury and hypoparathyroidism was comparable between the two groups(P>0.05).One month after total thyroidectomy,there was no significant difference in thyroglobulin levels between the two groups(P>0.05).The numerical score system(NSS)scores for postoperative esthetics related to the incision were significantly higher in the robotic group than in the open group(P<0.001).Conclusions:BABA-RT is safe and feasible for the treatment of PTC.Its surgical effect is equivalent to that of COT,and BABA-RT leads to significantly better postoperative cosmetic outcomes.