经口腔前庭腔镜下甲状腺腺叶切除学习曲线和62例手术经验

The Learning Curve of Transoral Thyroid Lobectomy Vestibular Approach(TOETVA),with 62 Case Surgical Experience

目的:探讨经口腔前庭腔镜下甲状腺癌腺叶切除的学习曲线,附62例手术经验分享。方法:回顾性分析2019年7月—2020年7月在我院行经口腔前庭腔镜下甲状腺腺叶切除62例病例资料,统计手术时间和术后并发症情况等分析学习曲线,并介绍经口腔前庭腔镜甲状腺手术技巧。结果:62例经口腔前庭腔镜下甲状腺手术顺利完成,前2例为先经乳晕入路腔镜下分离颈部空间后再在经口腔前庭建立操作孔,全部手术均无中转开放手术,术中空间显露均良好,均全程解剖喉返神经隧道,短暂性喉返神经损伤4例,无永久喉返神经损伤,术后甲状旁腺短暂性功能低下7例,随访3个月后均恢复正常。当到达16例时手术时间可见拐点,技能掌握期与熟练期建腔时间、腺叶切除时间采用t检验,差别有统计学意义,手术并发症无统计学意义。结论:经口腔前庭腔镜下甲状腺腺叶切除学习曲线为16例,在腔镜甲状腺熟练掌握下,结合"帽檐Trocar"和喉返神经隧道解剖技术,可顺利开展。

Objective:To explore the learning curve of transoral vestibular endoscopic thyroid lobectomy(TOETVA),with 62 cases of surgical experience sharing.Methods:A retrospective analysis of 62 cases of TOETVA in our hospital from July 2019 to July 2020,the operation time,postoperative complications and learning curve were analyzed and introduce the surgical skills in our department.Results:62 cases of TOETVA were successfully completed,the first 2 cases were through areola approach to separate the neck space under endoscope,and then establish the operation hole through oral vestibule,all operations were not converted to open surgery,intraoperative space exposure were good,the whole process of dissecting RLN tunnel,4 cases of transient RLN injury,no permanent RLN injury,there were 7 cases of temporary glandular hypofunction,and recovered to normal after 3 months of follow-up.When 16 cases were reached,the inflection point of operation time could be seen,t test was used to analyzed the time of cavity building and lobectomy in skill acquisition period and proficiency period,and the difference was statistically significant.There was no statistical significance in surgical complications.Conclusion:The proficiency case was case 16,which can be carried out smoothly under the mastery of endoscopic thyroid,combined with“brim trocar”and RLN tunnel anatomy skills.