经腋窝无充气后方入路腔镜甲状腺系膜切除术清扫右侧喉返神经深层(ⅥB区)淋巴结350例回顾性分析

Retrospective analysis of 350 cases with dissection of lymph nodes posterior to right recurrent laryngeal nerve in endoscopic thyroidectomy through gasless axillary posterior approach

目的:探索经腋窝无充气后方入路腔镜甲状腺系膜切除术在清扫右侧喉返神经深层(ⅥB区)淋巴结的安全性及可行性。方法:回顾性分析2020年6月至2022年12月,南方医科大学南方医院普通外科采用经腋窝无充气后方入路腔镜甲状腺系膜切除术进行治疗的右侧甲状腺乳头状癌(PTC)患者资料,术式均为甲状腺右侧叶及峡部切除术+右侧中央区淋巴清扫术。总结患者的临床、病理特点和术后并发症情况。采用SPSS 25.0软件对数据进行统计分析。结果:共入组350例患者,其中女性303例,男性47例,年龄(36.3±9.2)岁。pT1a期287例,pT1b期62例,pT2期1例,无T3及T4期患者。患者均顺利完成手术,没有中转开放。右侧中央区淋巴结清扫数目为(8.11±4.65)枚(范围:1~31枚)。右侧ⅥB区淋巴结清扫数目为(2.62±1.86)枚(范围:1~12枚)。14.86%(52/350)的患者存在ⅥB区淋巴结转移,0.86%(3/350)出现暂时性喉返神经损伤,0.86%(3/350)出现术后血肿。结论:经腋窝无充气后方入路腔镜甲状腺系膜切除术可以清扫ⅥB区淋巴结,是安全可行的。

ObjectiveTo evaluated the safety and feasibility of dissection of lymph nodes posterior to right recurrent laryngeal nerve(ⅥB compartment)in endoscopic thyroidectomy through gasless axillary posterior approach.MethodsA total of 350 cases with right lobe papillary thyroid carcinoma(PTC)who underwent endoscopic lobectomy,isthmusectomy and central compartment neck dissection via gasless axillary posterior approach based at the Department of General Surgery,Nanfang Hospital,Southern Medical University from June 2020 to December 2022 were retrospectively analyzed.Summarize the clinical,pathological characteristics,and postoperative complications of the patients.SPSS 25.0 was used for statistical analysis of the data.ResultsAll 350 patients underwent endoscopic surgery successfully,with no conversion to open surgery.There were 303 females and 47 males,with an average age of(36.3±9.2)years.Of those,287 patients were in pT1a stage,62 in pT1b stage,and one patient in pT2 stage.There was no T3 or T4 stage patient.The mean numbers of yielded lymph nodes in right central compartment andⅥB compartment were 8.11±4.65(range,1-31)and 2.62±1.86(range,1-12),respectively.ⅥB compartment metastasis was detected in 52(14.86%)of 350 patients.The incidence of transient recurrent laryngeal nerve injury was 0.86%(3/350).Postoperative hematoma occurred in three patients(0.86%).ConclusionThe dissection ofⅥB compartment in endoscopic thyroidectomy through gasless axillary posterior approach is safe and feasible in selected PTC patients.