经口腔前庭入路与双侧腋窝乳晕入路机器人甲状腺手术的回顾性比较研究

A retrospective comparative study between robotic thyroidectomy through transoral vestibular approach and bilateral breast-axillary approach

目的比较经口腔前庭入路与双侧腋窝乳晕入路机器人甲状腺癌手术的临床效果。方法回顾性分析2020年7月至2022年5月在解放军第九六〇医院甲状腺乳腺外科接受经口腔前庭入路(经口组)或经双侧腋窝乳晕入路(经腋乳组)机器人甲状腺癌根治术的患者的临床资料。经口组48例,经腋乳组52例,均接受单侧腺叶+峡部切除+中央区淋巴结清扫术。使用倾向性评分匹配法对两组患者根据性别、年龄、体重指数、肿瘤大小和位置及是否合并桥本甲状腺炎进行1∶1匹配,卡钳值为0.03,成功匹配两组患者各31例。经口组男性5例,女性26例,年龄(33.2±7.9)岁(范围:21~53岁);经腋乳组男性4例,女性27例,年龄(34.6±9.2)岁(范围:19~58岁)。采用独立样本t检验、Mann-Whitney U检验、χ^(2)检验或Fisher确切概率法比较两组患者的临床疗效。结果患者均顺利完成机器人甲状腺手术,无中转开放手术。与经腋乳组患者相比,经口组患者的手术时间更长[(211.3±57.2)min比(126.2±37.8)min,t=6.915,P<0.01],引流管留置时间更短[(5.4±1.0)d比(6.4±1.2)d,t=-3.544,P=0.001],住院时间更短[(6.6±1.2)d比(7.4±1.3)d,t=-2.353,P=0.022],术后美容评分更高[(9.46±0.25)比(9.27±0.26),t=2.925,P=0.005]。两组患者的中央区淋巴结清扫数目、中央区淋巴结转移数目和术后并发症发生率的差异均无统计学意义(P值均>0.05)。结论在经过严格选择的患者中,经口腔前庭入路的手术效果与经腋乳入路相似,但术后恢复更快,住院时间更短。对于美容要求较高的患者,经口腔前庭入路是一种可行的手术方式。

Objective To compare the surgical outcome of robotic thyroidectomy through transoral approach and the bilateral breast-axillary approach.Methods Retrospective analysis was made on the clinical data of patients who performed transoral robotic thyroidectomy(TORT group)or bilateral breast-axillary approach(BABA group)in the Department of Thyroid and Breast Surgery,the 960th Hospital of People′s Liberation Army from July 2020 to May 2022.Both groups received lobectomy with lymph node dissection of the central region.A total of 100 cases were included in the study,including 48 cases in the TORT group and 52 cases in the BABA group.The propensity score matching method was used for 1∶1 matching of patients between the 2 groups,with a match tolerance of 0.03.There were 31 patients in each group successfully matched.In the TORT group,there were 5 males and 26 females,aged(33.2±7.9)years(range:21 to 53 years).While there were 4 males and 27 females in the BABA group,aged(34.6±9.2)years(range:19 to 58 years).The t test,Mann-Whitney U test,χ^(2) test or Fisher exact test were used to compare the clinical efficacy between the two groups.Results All the patients successfully completed robotic thyroid surgery without conversion to open surgery.Compared with BABA group,the TORT group had longer operation time((211.3±57.2)minutes vs.(126.2±37.8)minutes,t=6.915,P<0.01),shorter drainage tube retention time((5.4±1.0)days vs.(6.4±1.2)days,t=-3.544,P=0.001),shorter total hospital stay((6.6±1.2)days vs.(7.4±1.3)days,t=-2.353,P=0.022),and higher cosmetic score(9.46±0.25 vs.9.27±0.26,t=2.925,P=0.005).There was no significant difference between the two groups in the number of lymph nodes dissection,metastasis in the central compartment,and the incidence of postoperative complications(all P>0.05).Conclusions Compared with the bilateral breast-axillary approach,the transoral vestibular approach of robotic thyroidectomy is also safe and effective.It shows similar surgical results to the bilateral breast-axillary approach in strictly selected patients,but the postoperative recovery speed is much faster,and the hospital stay is shorter.Transoral robotic thyroidectomy is a more recommended surgical method for patients with high aesthetic demand.