机器人经双侧腋窝和乳晕入路甲状腺手术的初步经验(附40例报告)  

Experience of robotic thyroid surgery via bilateral axillo-breast approach: a report of 40 cases

作　　者：翁原驰[1] 吴志翀[1] 陈曦[1] 杨卫平[1] 邓侠兴[1] 严佶祺[1] 沈柏用[1] 彭承宏[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院外科,上海200025

出　　处：《外科理论与实践》2016年第6期517-520,共4页Journal of Surgery Concepts & Practice

摘　　要：目的：探讨达芬奇机器人经双侧乳晕和腋窝途径（bilateral axillo-breast approach,BABA）入路甲状腺手术的安全性与可行性。方法：2015年5月至2016年7月我院运用达芬奇机器人手术系统完成机器人BABA入路甲状腺手术共40例。分析病人手术情况、术后并发症发生及美容满意度。结果：40例均顺利完成机器人BABA入路甲状腺手术,包括甲状腺大部切除术5例,单侧甲状腺腺叶切除7例;单侧甲状腺腺叶＋峡部及锥体叶切除＋中央区淋巴结清扫24例,单侧甲状腺腺叶＋峡部及锥体叶切除＋中央区淋巴结清扫＋对侧甲状腺大部切除4例。平均手术时间（124.1±34.6）（70-225）min,平均术中出血（7.4±6.5）（2-40）m L,术后平均住院时间（2.3±0.7）（1-4）d。术后病理提示甲状腺乳头状癌28例,结节性甲状腺肿9例,甲状腺腺瘤3例。无术后出血。术后暂时性喉返神经损伤1例,甲状旁腺功能减退3例,所有病人均未出现永久性喉返神经损伤及永久性甲状旁腺功能减退。术后中位随访时间7（1-14）个月,无甲状腺术区、淋巴结、皮下隧道复发或转移。40例对手术美容效果非常满意。结论：达芬奇机器人BABA入路甲状腺手术安全可行,手术美容效果好。Objective To explore the safety and feasibility of robotic thyroid surgery via bilateral axillo-breast approach（BABA）. Methods From May 2015 to July 2016, 40 patients underwent robotic thyroid surgery via BABA in our hospital. The perioperative parameters, postoperative complications of the patients and the satisfaction of appearance were analyzed. Results Operations were performed successfully on all 40 patients via BARA including 5 cases with unilateral subtotal thyroidectomy, 7 cases with unilateral thyroid lobectomy, 24 cases of unilateral thyroid lobectomy combined with the resection of isthmus and pyramidal lobe and central lymph node dissection, and 4 cases of unilateral thyroid lobectomy with the resection of isthmus and pyramidal lobe and central lymph node dissection and contralateral side subtotal thyroidectomy. The operation time was（124.1 ±34.6）（70-225） min with the blood loss（7.4 ±6.5）（2-40） m L. The postoperative hospital stay was（2.3±0.7）（1-4） d. It was shown by postoperative pathological examination 28 patients with thyroid papillary carcinoma, 9 patients with nodular goiter and 3 patients with thyroid adenoma. No postoperative hemorrhage was observed.Transient recurrent laryngeal nerve injury occurred in 1 case and transient hypoparathyroidism in 3 cases. There was no both permanent recurrent laryngeal nerve injury and permanent hypoparathyroidism. No tumor recurrence of the cases was found during the period of followed-up from 1 to 14 months with median 7 months. All 40 patients were satisfied with the cosmetic effect of surgery. Conclusions Robotic thyroid surgery via BABA is safe and feasible with good cosmetic results.

关 键 词：达芬奇机器人手术 机器人甲状腺手术 经双侧腋窝和乳晕途径入路 

分 类 号：R653[医药卫生—外科学]