BABA径路机器人外科手术系统在甲状腺癌颈侧区淋巴结清扫术中的临床应用

Clinical Application of Robotic Surgical System via BABA in Lateral Lymph Node Dissection for Thyroid Cancer

目的:探讨达芬奇机器人外科手术系统经双侧腋窝乳晕径路行甲状腺癌颈侧区淋巴结清扫术的安全性、可行性和有效性。方法:回顾性分析2014年11月至2021年12月在解放军第九六〇医院接受颈侧区淋巴结清扫的甲状腺乳头状癌患者资料。根据手术方式分为开放组(n=493例)和机器人组(n=467例),颈侧区淋巴结清扫范围至少包括Ⅱ、Ⅲ、Ⅳ区。使用倾向性评分匹配法对两组患者的性别、年龄、体重指数、肿瘤最大直径、是否合并桥本甲状腺炎、是否清扫Ⅴb区淋巴结、是否清扫双侧颈侧区淋巴结进行1∶1匹配,卡钳值为0.02,成功匹配两组患者各454例。开放组男性91例,女性363例,年龄(40.5±9.9)岁,机器人组男性84例,女性370例,年龄(40.8±9.8)岁。比较两组患者的手术指标、并发症发生率、颈侧区各区域淋巴结转移和清扫数目、术后随访结果。结果:匹配前,机器人组年龄小于开放组,差异有统计学意义(t=1.994,P=0.046),匹配后,两组患者的基线资料差异无统计学意义(P> 0.05)。机器人组患者术后疼痛视觉模拟评分更低(t=10.326,P <0.001),Ⅱ区淋巴结清扫数目更多(t=-2.610,P=0.009),术后美容评分更高(t=-261.845,P <0.001)。两组患者的颈侧区淋巴结转移率、颈侧区淋巴结清扫数目、术中出血量、术后住院天数、并发症发生率、Ⅱ、Ⅲ、Ⅳ、Ⅴb区淋巴结转移数目、Ⅲ、Ⅳ、Ⅴb区淋巴结清扫数目、术后3个月吞咽不适感、颈部麻木感发生率、肿瘤复发率差异无统计学意义(P> 0.05)。结论:BABA径路达芬奇机器人外科手术系统在甲状腺癌颈侧区淋巴结清扫术中的应用是安全、可行且有效的,且Ⅱ区淋巴结清扫数目更多,术后疼痛不适感更低,美容满意度更高。

Objective: To explore the safety, feasibility and effectiveness of Da Vinci robotic surgical system via bilateral axillo-breast approach(BABA) in lateral cervical lymph node dissection for thyroid cancer. Methods: Data of patients with papillary thyroid cancer who underwent lateral cervical lymph node dissection in the 960th Hospital of the PLA from November 2014 to December 2021 were retrospectively analyzed. They were assigned to the open group(n = 493) and the robot group(n = 467) according to surgical method, and the extent of lateral cervical lymph node dissection included at least level II, III and IV. Propensity score matching(PSM) was used to match the two groups in terms of sex, age, body mass index, maximum tumor diameter, whether combined with Hashimoto's thyroiditis, whether level Vb lymph nodes were cleared, and whether bilateral lateral cervical lymph nodes were cleared, with the ratio of 1∶1 and the caliper value of 0.02, and the two groups were successfully matched with 454 patients in each group. There were 91 males and 363 females in the open group, aged(40.5 ± 9.9) years, and 84 males and 370 females in the robot grou, aged(40.8 ± 9.8) years. The surgical indexes, complication rate, number of metastasis and dissected lymph nodes in each region of lateral neck zone, and postoperative follow-up results were compared between the two groups. Results:Before PSM, the age of the robot group was significantly younger than that of the open group(t = 1.994,P = 0.046), and there were no statistically significant differences in the baseline data between the two groups after PSM(P > 0.05). Patients in the robot group had a lower visual analog scale score(t = 10.326,P < 0.001), a higher number of dissected lymph nodes in level II(t =-2.610,P = 0.009), and a higher postoperative cosmetic score(t =-261.845,P < 0.001). There were no statistically significant differences between the two groups in the rate of lymph node metastasis in the lateral cervical region, the number of dissected lymph nodes in the lateral cervical region, the amount of intraoperative bleeding, postoperative length of stay, the rate of complications, the number of metastatic lymph nodes in level II, III, IV and Vb, the number of dissected lymph nodes in level III, IV and Vb, the incidence of dysphagia three months after surgery, the incidence of numbness in the neck three months after surgery, and the rate of tumor recurrence three months after surgery(P > 0.05). Conclusion: The application of Da Vinci robotic surgical system via BABA in lateral cervical lymph node dissection for thyroid cancer is safe, feasible and effective, with more dissected lymph nodes in level II, lower postoperative pain and discomfort, and higher cosmetic satisfaction.