经口腔前庭入路机器人辅助甲状腺手术107例临床分析

Transoral robotic thyroidectomy via vestibular approach:a retrospective study of 107 cases in a single center

目的探讨经口腔前庭入路机器人辅助甲状腺手术的近期疗效。方法本研究为回顾性病例系列研究。回顾性分析2020年5月至2023年8月在联勤保障部队第九六〇医院甲状腺乳腺外科接受经口腔前庭入路机器人辅助甲状腺手术的107例患者的临床病理学特点和术后情况。男性12例,女性95例;年龄(31.8±9.4)岁(范围:11~55岁)。甲状腺良性肿瘤20例;恶性肿瘤87例,均为乳头状癌。术后通过门诊、电话等进行随访,主要观察术后并发症恢复情况、是否复发和美容效果等。结果107例患者均成功完成经口腔前庭入路机器人辅助甲状腺手术,无中转开放手术。甲状腺乳头状癌患者肿瘤最大径(5.6±2.7)mm(范围:2~15 mm);其中45例发生颈部中央区淋巴结转移,清扫中央区淋巴结数目[M(IQR)]11(8)枚(范围:3~26枚),转移淋巴结数目1(3)枚(范围:0~13枚)。术后未发生喉返神经损伤和永久性甲状旁腺功能减退,暂时性甲状旁腺功能减退率8例。其他并发症包括术后感染1例,左颌下皮肤穿孔1例,皮肤烫伤1例,口角撕裂2例,口唇麻木1例。术后住院时间6(2)d(范围:3~11 d)。随访(22.6±10.0)个月(范围:1.0~37.4个月)的随访,患者未发生局部淋巴结复发或转移。所有患者对术后美容效果满意,术后1个月患者的颈部美学效果评分为9.3(0.2)(范围8.4~9.6)。结论对于严格筛选的早期甲状腺癌患者,由经验丰富的医生行经口腔前庭入路机器人辅助甲状腺手术是安全可行的,同时有理想的美容效果。

Objective To investigate the short-term outcome of transoral robotic thyroidectomy.Methods This is a retrospective case series study.The clinicopathologic characteristics and postoperative results of 107 patients who underwent transoral robotic thyroidectomies in the Department of Thyroid and Breast Surgery of the 960th Hospital of People′s Liberation Army from May 2020 to August 2023 were retrospectively analyzed.There were 12 males and 95 females,with an age of(31.8±9.4)years(range:11 to 55 years),including 20 benign tumors and 87 thyroid papillary carcinoma.Postoperative follow-up was carried out through returning visit and telephone,mainly to observe the recovery of postoperative complications,cosmetic effects and recurrence results.Results All transoral robotic thyroidectomy was successfully completed without conversion to open surgery.The tumor size of thyroid papillary carcinoma patients was(5.6±2.7)mm(range:2 to 15 mm).Furthermore,central cervical lymph node metastasis was found in 45 cases.The number of central cervical lymph nodes retrieved and metastasized(M(IQR))were 11(8)(range:3 to 26)and 1(3)(range:0 to 13),respectively.There was no recurrent laryngeal nerve injury and permanent hypoparathyroidism.The transient hypoparathyroidism after surgery was 8 cases.Other complications occurred as follows:postoperative infection(n=1),left submandibular perforation(n=1),skin scald(n=1),and perioral numbness(n=1),oral tear(n=2).The postoperative stay was 6(2)days(range:3 to 11 days).No local lymph node recurrence or metastasis occurred after a follow-up of(22.6±10.0)months(range:1.0 to 37.4 months).All patients were satisfied with the postoperative cosmetic results,the aesthetic effect score was 9.3(0.2)(range:8.4 to 9.6)one month after surgery.Conclusion For highly screened patients with early thyroid cancer,experienced surgeons can perform a transoral robotic thyroidectomy that has excellent cosmetic results.