机器人在肥胖甲状腺癌患者颈侧区淋巴结清扫术中的应用

Utilization of robotic lateral cervical lymph node dissection for obese patients with thyroid carcinoma

目的探讨经双侧腋窝乳晕入路达芬奇机器人手术系统在肥胖甲状腺癌患者颈侧区淋巴结清扫术中的临床效益及应用价值。方法回顾性分析2018年1月-2023年6月中国人民解放军联勤保障部队第九六〇医院甲状腺乳腺外科收治的117例接受颈侧区淋巴结清扫治疗的甲状腺癌患者的临床资料。其中男性55例,女性62例,年龄17~64岁,平均(36.05±8.77)岁。根据体重指数将患者分为正常组(18.5 kg/m^(2)≤体重指数<24 kg/m^(2),n=60)和肥胖组(体重指数≥28 kg/m^(2),n=57)。比较两组患者的性别、年龄、体重指数、手术时间、术后引流液体量、肿瘤最大径、中央区淋巴结清扫及转移数目、颈侧区淋巴结清扫及转移数目、术后住院时间、术后美容效果满意评分及手术并发症等情况。应用SPSS 26.0统计软件对数据进行分析。结果所有患者均顺利完成手术,两组均未中转开放手术。肥胖组体重指数高于正常组[(31.35±3.08)kg/m^(2)比(22.53±0.82)kg/m^(2),t=20.97,P<0.05]。肥胖组的肿瘤最大径大于正常组[(13.81±10.70)mm比(10.42±5.53)mm,t=2.17,P<0.05]。两组患者的手术时间、中央区淋巴结清扫及转移数目、颈侧区淋巴结清扫及转移数目及术后并发症等差异均无统计学意义(P>0.05)。结论机器人手术系统在肥胖甲状腺癌患者颈侧区淋巴结清扫术中的应用安全可行,没有增加手术风险和并发症,为肥胖甲状腺癌患者颈侧区淋巴结清扫提供了一个新的治疗选择。

ObjectiveTo investigate the clinical benefit and application value of the Da Vinci robotic surgical system through bilateral axillary areolar approach in cervical lymph node dissection in obese thyroid carcinoma patients.MethodsThe clinical data of 117 patients with thyroid cancer admitted to the thyroid and breast surgery Department of the 960th Hospital of the Chinese PLA Joint Logistic Support Force from January 2018 to June 2023 were retrospectively analyzed.There were 55 males and 62 females,aged from 17 to 64 years,with an average age of(36.05±8.77)years.According to body mass index(BMI),patients were divided into normal group(18.5 kg/m^(2)≤BMI<24 kg/m^(2),n=60)and obese group(BMI≥28 kg/m^(2),n=57).Gender,age,BMI,operation time,postoperative drainage fluid volume,tumor diameter,central lymph node dissection and number of metastasis,cervical lymph node dissection and number of metastasis,postoperative hospital stay,postoperative aesthetic satisfaction score and surgical complications of the two groups were analyzed.SPSS 26.0 statistical software was used to analyze the data.ResultsAll of patients completed the operation successfully,and neither group was transferred to open surgery.The BMI of obese group was higher than that of normal group[(31.35±3.08)kg/m^(2) vs(22.53±0.82)kg/m^(2),t=20.97,P<0.05].The maximum tumor diameter in the obese group was greater than that in the normal group[(13.81±10.70)mm vs(10.42±5.53)mm,t=2.17,P<0.05].There were no significant differences in operation time,number of central lymph node dissection and metastasis,number of cervical lymph node dissection and metastasis and postoperative complications between the two groups(P>0.05).ConclusionsUtilization of the Da Vinci robotic surgical system via the BABA approach demonstrates both safety and feasibility in obese patients with thyroid carcinoma undergoing lateral cervical lymph node dissection.Importantly,this technique does not increase the risk of surgical complications,thus providing a novel alternative for lateral cervical lymph node dissection in obese thyroid carcinoma patients.