达芬奇机器人与腔镜甲状腺癌根治术的对比研究

Comparative study of Da Vinci robotic and endoscopic radical thyroidectomy

目的:对比达芬奇机器人与腔镜甲状腺癌根治术的临床疗效。方法:回顾性收集2019年7月1日至2022年8月21日行甲状腺癌根治术的165例患者的临床资料,其中达芬奇机器人甲状腺手术(机器人组)81例,腔镜甲状腺手术(腔镜组)84例,手术均由同一术者及其助手实施。术前患者均签署知情同意书。比较两组手术相关指标、术前及术后第1天血清钙、甲状旁腺激素及甲状旁腺、喉返神经损伤情况。结果:手术均顺利完成,两组均未中转开放手术。腔镜组手术时间短于机器人组[124(105,135)min vs.150(120,162.5)min,P<0.05],机器人组淋巴结清扫数量多于腔镜组[6(4,11)枚vs.4(2,7)枚,P<0.05],机器人组术后第1天甲状旁腺激素浓度高于腔镜组[24.5(15.2,31.4)pg/mL vs.20.9(14.4,25.5)pg/mL,P<0.05]。两组术中出血量、术后引流量、术后低钙血症及暂时性甲状旁腺功能减退等差异无统计学意义。术后两组均未出现出血、喉返神经暂时性或永久性麻痹、永久性甲状旁腺功能低下等并发症。结论:与腔镜甲状腺手术相比,达芬奇机器人甲状腺癌根治术淋巴结清扫数量更多,为甲状腺癌的手术治疗提供了新思路。

Objective:To compare the clinical efficacy of Da Vinci robotic and endoscopic radical thyroidectomy.Methods:The clinical data of 165 patients who suffered from thyroid cancer and underwent radical thyroidectomy from Jul.1,2019 to Aug.21,2022 were retrospectively collected,including 81 cases of Da Vinci robotic thyroidectomy(robot group)and 84 cases of endoscopic thyroidectomy(endoscopic group),all performed by the same surgeon and his assistant.All patients signed informed consent before operation.The surgery-related indexes,preoperative and postoperative serum calcium,parathyroid hormone and injury of parathyroid gland and recurrent laryngeal nerve were compared between the two groups.Results:All operations were successfully completed,and no conversion to open surgery occurred in either group.The operation time of endoscopic group was shorter than that of robot group,and the difference was statistically significant[124(105,135)min vs.150(120,162.5)min,P<0.05];the number of dissected lymph nodes in the robot group was more than that in the endoscopic group[6(4,11)vs.4(2,7),P<0.05];the parathyroid hormone concentration in the robot group was higher than that in the endoscopic group on postoperative day 1,and the difference was statistically significant[24.5(15.2,31.4)pg/mL vs.20.9(14.4,25.5)pg/mL,P<0.05].There was no significant difference in intraoperative blood loss,postoperative drainage volume,postoperative hypocalcemia and temporary hypoparathyroidism between the two groups(P>0.05).There were no postoperative complications such as hemorrhage,temporary or permanent paralysis of recurrent laryngeal nerve and permanent hypoparathyroidism in both groups.Conclusions:Compared with endoscopic thyroidectomy,the number of lymph nodes dissected is more in Da Vinci robotic radical thyroidectomy,which provides a new idea for the surgical treatment of thyroid cancer.