腔镜与机器人甲状腺手术治疗甲状腺微小乳头状癌的对比研究

A Comparative Study of Endoscopic and Robotic Thyroidectomies for Papillary Thyroid Microcarcinoma

目的:探讨达芬奇机器人手术系统与腔镜手术系统治疗甲状腺微小乳头状癌的安全性及有效性。方法:回顾性分析2016年1月至2021年1月解放军第九六〇医院甲状腺乳腺外科收治的144例甲状腺微小乳头状癌患者的临床资料,其中机器人甲状腺手术患者(机器人组)83例,腔镜甲状腺手术患者(腔镜组)61例,比较两组患者的手术时间、术后住院时间、术后引流液体量、淋巴结清扫个数、美容效果满意度及手术并发症等情况。应用SPSS20.0统计软件对结果进行分析,比较计量资料采用t检验,比较计数资料采用χ^(2)检验。通过门诊、电话、微信等对患者进行随访。结果:所有患者手术均顺利完成,两组均未中转开放手术。腔镜组手术准备时间(32.46±1.11)min及手术操作时间(146.34±28.70)min明显长于机器人组(19.74±1.52)min及(110.78±16.08)min(P<0.05);而机器人组患者的淋巴结清扫数目(10.29±6.41)枚多于腔镜组(7.72±3.47)枚(P<0.05)。两组患者的术后引流液体量、术后平均住院时间及美容效果满意度的差异无统计学意义(P>0.05)。机器人组与腔镜组随访时间分别为(26.69±17.86)月、(29.12±17.67)月,范围为1~61个月,所有患者均无复发转移,均无永久性喉返神经损伤及永久性甲状旁腺功能减退发生。结论:达芬奇机器人手术系统在甲状腺微小乳头状癌的治疗中安全可行,与腔镜甲状腺手术相比,手术时间短,淋巴结清扫数目多,给有美容需求的患者提供了新的选择。

Objective:To discuss the safety and effectiveness of da Vinci surgical system and endoscopic surgical system in the treatment of papillary thyroid microcarcinoma.Methods:Clinical data of 144 papillary thyroid microcarcinoma(PTMC)patients from the department of thyroid and breast surgery in the 960th Hospital of PLA between January 2016 and January 2021 were retrospectively analyzed.The patients were treated by either robotic thyroidectomy(the robot group,83 cases)or endoscopic thyroidectomy(the endoscopy group,61 cases).Two groups were compared in surgical time,post-operative length of stay,postoperative amount of fluid drained,number of dissected lymph nodes,cosmetic effect and complications.SPSS Statistics 20.0 was used for statistical analyses.The measurement data were compared by t-test,and the count data by χ^(2) test.Patients were followed up through outpatient visits,telephone,WeChat,etc.Results:All the operations were successfully completed,neither group converted to open surgery.The preparation time[(32.46±1.11)min]and the surgical time[(146.34±28.70)min]in the endoscopic group were significantly longer than those in the robot group[(19.74±1.52)min and(110.78±16.08)min,(P<0.05)],while the number of dissected lymph nodes in the latter(10.29±6.41)was higher than in the former(7.72±3.47)(P<0.05).Differences between the two groups were not statistically significant in postoperative amount of fluid drained,postoperative length of stay and cosmetic effect(P>0.05).The follow-up time(1~61 months)in the robot group and the endoscopy group were(26.69±17.86)months and(29.12±17.67)months,respectively,without recurrence or metastasis.Neither permanent recurrent laryngeal nerve palsy nor permanent hypoparathyroidism were not observed.Conclusion:The da Vinci surgical system is safe and feasible for papillary thyroid microcarcinoma,with comparatively shorter surgical time and a larger number of dissected lymph nodes compared to endoscopic thyroidectomy,providing new options for patients with cosmetic needs.