经口达芬奇机器人甲状腺手术29例临床分析

Transoral Robotic Thyroidectomy Vestibular Approach:A Clinical Analysis of 29 Patients

目的:通过分析29例经口腔前庭入路达芬奇机器人甲状腺切除术(transoral robotic thyroidectom yvestibular approach,TORTVA)的临床疗效,总结经口腔前庭入路机器人甲状腺手术的初步经验。方法:回顾性分析2017年12月至2021年2月共29例在陆军特色医学中心乳腺甲状腺外科接受TORTVA患者的病例资料,分析其临床病理特征、手术方式及时间、术后并发症及住院时间等。结果:29例患者中,女性25例,男性4例;平均年龄(36.31±8.30)岁,平均肿瘤大小(1.07±0.73)cm。其中25例甲状腺乳头状癌,4例甲状腺良性病变。行单侧甲状腺部分切除术3例,单侧甲状腺腺叶切除术1例,单侧甲状腺次全切除加中央区淋巴结清扫(central neck dissection,CND)2例,单侧甲状腺腺叶及峡部切除加CND22例,甲状腺次全切除1例。平均手术时间(253.10±51.55)min。平均清扫淋巴结数目(5.72±4.12)枚。术后未出现暂时性或永久性喉返神经损伤和低钙血症,9例患者术后发生颏神经暂时性麻痹。术后平均住院时间(2.48±0.97)d,平均随访时间(11.40±11.08)月,均未出现复发或转移。结论:通过严格把握手术适应症,TORTVA是安全可行的,但远期疗效仍有待进一步观察。

Objective:To observe the clinical efficacy and safety of Transoral robotic thyroidectomy vestibular approach(TORTVA),and summarize its experience in thyroid surgery.Methods:Data of 29 patients receiving TORTVA(from our hospital from December 2017 to February 2021),such as pathological characteristics,operation methods,postoperative complications and length of stay,were retrospectively analyzed.Results:Among the 29 cases(25 cases of papillary thyroid carcinoma and 4 cases of benign thyroid lesions),25 were women,and 4 were men;the average age was(36.31±8.30)years;and the average tumor size was(1.07±0.73)cm.3 cases underwent unilateral partial thyroidectomy;1 underwent unilateral thyroid lobectomy;2 underwent unilateral subtotal thyroidectomy plus central neck dissection;22 underwent unilateral thyroid lobectomy plus isthmus resection plus central neck dissection;and 1 underwent subtotal thyroidectomy.The aver age operation time was(253.10±51.55)minutes.The average number of dissected lymph nodes was 5.72±4.12.Neither temporary/permanent recurrent laryngeal nerve(RLN)injury nor postoperative hypocalcemia was observed;and postoperative transient mandibular nerve palsy was observed in 9 cases.The average postoperative length of stay was(2.48±0.97)days.The average follow-up time was(11.40±11.08)months.Neither recurrence nor metastasis was observed.Conclusion:TORTVA is safe and feasible after strictly considering surgical indications,the long-term prognosis of which,however,still needs to be further observed.