经口腔镜手术治疗甲状旁腺腺瘤临床疗效分析

Clinical effects of transoral endoscopic parathyroidectomy via vestibular approach for parathyroid adenoma

目的探讨经口腔前庭入路腔镜手术治疗甲状旁腺腺瘤的安全性和有效性。方法回顾性分析2017年12月至2019年3月浙江大学医学院附属第二医院甲状腺外科收治的24例甲状旁腺瘤病人的临床资料,其中7例病人选择经口腔镜手术,另17例病人行开放手术治疗。对比分析两组病人手术时间、术中出血量、术后视觉模拟评分(VAS)、术后引流量、住院时间及并发症发生情况。结果两组在术式、肿瘤大小、肿瘤位置方面相匹配,术后病理学检查均为甲状旁腺腺瘤,腔镜组无中转开放手术。两组病人术中出血量、并发症发生率、住院时间比较差异无统计学意义(P>0.05)。在并发症方面,腔镜组有3例病人发生暂时性手足麻木,1例术后皮下积液感染,1例口角轻微破损;开放组有5例暂时性手足麻木。两组均无暂时性或永久性喉返神经损伤和术后血肿发生。腔镜组与开放组的手术时间[(148.6±43.9)min vs.(67.1±27.0)min]、术后引流量[(147.6±25.7)mL vs.(78.3±27.2)mL]相比差异有统计学意义。腔镜组病人术后VAS评分低于开放组。随访3~18个月均无复发。结论经口腔前庭入路腔镜手术治疗甲状旁腺腺瘤安全可行且有效,同时具有无瘢痕的美容效果。

Objective To investigate the safety and effectiveness of transoral endoscopic parathyroidectomy via vestibular approach(TOEPVA)for parathyroid adenoma.Methods The clinical data of 24 patients with parathyroid adenoma admitted from December 2017 to March 2019 in Department of Breast Surgery,the Second Hospital of Zhejiang University School of Medicine were analyzed retrospectively.Seven patients underwent TOEPVA and 17 patients underwent open surgery.The differences in demographic indicators such as patient age,gender,tumor size,as well as the operation time,intraoperative blood loss,postoperative VAS(visual analogue scale)score,postoperative drainage,hospital stay,and complications were demonstrated and statistically analyzed.Results The two groups were matched in terms of surgical procedure,tumor size,and tumor location.All the postoperative pathologys were parathyroid adenoma,and there was no transition to open surgery in the endoscopic group.There was no significant difference in intraoperative blood loss,the incidence of complications,and hospital stay duration between the two groups(P>0.05).Endoscopic group:3 cases of temporary limb numbness,1 case of postoperative subcutaneous hydrops and infection,1 case of slight mouth damage;Open group:5 cases of temporary limb numbness.There was no temporary or permanent recurrent laryngeal nerve injury or postoperative hematoma in either group.There was no statistically significant difference between the endoscopic group and the open group in operation time and postoperative drainage volume[(148.6±43.9)min vs.(67.1±27.0)min,(147.6±25.7)mL vs.(78.3±27.2)mL].The postoperative VAS score of the endoscopic group was lower than that of the open group.No recurrence was found in both groups during follow-up for 3-18 months.Conclusion The TOEPVA for the treatment of parathyroid adenoma is safe,feasible,and effective,which had a completely scar-free cosmetic effect.