经口腔前庭入路机器人甲状腺手术神经保护的探索

xploration of neuroprotection of transoral robotic thyroidectomy

目的探讨经口腔前庭入路达芬奇机器人甲状腺手术(transoral robotic thyroidectomy,TORT)中神经保护的方法。方法回顾性分析2020年5月至2021年11月于解放军第九六〇医院甲状腺乳腺外科行TORT的70例患者的临床资料,其中男8例、女62例,年龄15~55岁、平均年龄(31.59±9.65)岁;其中良性患者12例、恶性患者58例,所有患者均采用精细化被膜解剖联合术中神经监测(intraoperative neuromonitoring,IONM)的方法解剖显露喉返神经并规避喉上神经外支(external branch of superior laryngeal nerve,EBSLN),规避颏神经及面神经下颌缘支走行区域的方法保护其功能,统计甲状腺肿瘤患者的临床数据,并评估手术相关神经功能,应用SPSS 23.0软件进行统计学分析。结果本研究所有手术均顺利完成,无中转开放。所有病例中,因面神经下颌缘支损伤导致口角歪斜1例(1.4%)、暂时性喉返神经麻痹1例(1.4%),无颏神经、EBSLN及永久性喉返神经损伤。结论对于TORT,IONM解剖显露喉返神经并规避EBSLN可有效保护喉神经的功能,规避颏神经及面神经下颌缘支走行区域可降低相关神经损伤风险。

Objective To explore the method of nerve protection in da Vinci robotic thyroid surgery through oral vestibular approach.Methods The clinical data of 70 patients who underwent transoral da Vinci robotic thyroidectomy in the Department of Thyroid and Breast Surgery of 960th Hospital of PLA from May 2020 to Nov.2021 were retrospectively analysis,including 8 males and 62 females.The age ranged from 15 to 55 years old,with an average age of(31.59±9.65)years.Among them,there were 12 benign patients and 58 malignant patients.In all patients,the method of refined capsule dissection combined with intraoperative nerve monitoring was used to dissect the recurrent laryngeal nerve and avoid the superior laryngeal nerve,protect the function of the mental nerve and the marginal mandibular branch of facial nerve by avoiding the area where they run.The clinical data of thyroid tumor patients were collected and the neurological function related to surgery was evaluated.SPSS 23.0 software was used for statistical analysis.Results In this study,all operations were successfully completed with none transferred to open surgery.Among all the cases,1 case(1.4%)had a skewed corner of the mouth due to the marginal mandibular branch of facial nerve injury,1 case(1.4%)had temporary recurrent laryngeal nerve palsy,and there was no mental nerve,superior laryngeal nerve and permanent recurrent laryngeal nerve injury.Conclusions In robotic thyroid surgery through oral vestibular approach,refined capsule anatomy combined with intraoperative nerve monitoring anatomy to expose the recurrent laryngeal nerve and avoid the superior laryngeal nerve can effectively protect the function of the laryngeal nerve,and avoiding the mental nerve and marginal mandibular branch of facial nerve can reduce the risk of associated nerve injury.