达芬奇机器人治疗肿瘤直径大于2 cm甲状腺癌的临床研究  

Clinical study of da Vinci robotic thyroidectomy for thyroid cancer larger than 2 cm

作　　者：李小磊 朱见[1] 王梦迪 庄大勇[1] 郑鲁明[1] 周鹏[1] 岳涛[1] 贺青卿[1] Li Xiaolei;Zhu Jian;Wang Mengdi;Zhuang Dayong;Zheng Luming;Zhou Peng;Yue Tao;He Qingqing(Department of Thyroid and Breast Surgery,Jinan Military General Hospital of People′s Liberation Army,Jinan 250031,China)

机构地区：[1]济南军区总医院甲状腺乳腺外科,250031

出　　处：《中华腔镜外科杂志（电子版）》2018年第4期216-219,共4页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：国家自然科学基金项目(81702448);济南军区总医院院长基金资助项目(2016ZD02;2017MS04)

摘　　要：目的与开放手术相比较,评估经腋乳径路达芬奇机器人甲状腺手术治疗肿瘤直径大于2 cm甲状腺癌的手术安全性和肿瘤彻底性。方法回顾性分析2015年1月至2018年1月在济南军区总医院通过开放手术或机器人手术治疗肿瘤直径2~4 cm的甲状腺乳头状癌患者的临床资料。结果本研究包括行机器人甲状腺切除手术患者30例,行开放手术患者45例。机器人手术组与开放手术组的肿瘤直径均在2~4 cm,两组患者均行甲状腺全切及颈部淋巴结清扫术,机器人手术组均顺利完成,无中转开放手术。机器人手术组平均年龄为(36. 18±3. 5)岁,开放组平均年龄为(45. 90±2. 2)岁。机器人组平均手术时间为(146. 2±30. 5) min,显著长于开放组手术时间(95. 9±26. 2) min (P <0. 001)。两组均未发生永久性喉返神经损伤和甲状旁腺功能减退,两组在术后短暂性喉返神经损伤发生率和甲状旁腺功能减退发生率、术后引流量、住院时间、清扫淋巴结数目比较,差异无统计学意义(P> 0. 05)。术后美容效果数字评分系统得分,机器人手术组(9. 4±0. 4)分,显著优于开放组的(5. 2±1. 2)分(P <0. 05)。结论与开放手术相比,对肿瘤直径2~4 cm的甲状腺乳头状癌患者行机器人甲状腺手术可以保证手术安全性和肿瘤切除的彻底性,并且具有更好的美容效果,适合于在意颈部瘢痕的患者。Objective To evaluate the surgical safety and oncological completeness of da vinci robotic thyroidectomy via bilateral axillo- breast approach for thyroid carcinoma larger than 2 cm by comparing with conventional open thyroidectomy. Methods The clinical data of patients with papillary thyroid cancer measuring 2- 4 cm underwent robotic thyroidectomy or open thyroidectomy were collected and reviewed. Results This study included 30 patients received robotic thyroidectomy and 45 patients underwent open thyroidectomy. All the patient underwent total thyroidectomy and neck lymph node dissection. The cases in robotic thyroidectomy group were completed successfully, and no conversion to open surgery. The mean ages were （36.18 ± 3.5）years and （45.90 ± 2.2）years in robotic thyroidectomy group and open thyroidectomy group, respectively. The operation time of the robotic group was （146.2 ± 30.5） minutes, which was much longer than that of open group（95.9 ± 26.2） minutes （ P 〈 0.001）. There were no permanent recurrent laryngeal nerve injury and hypoparathyroidism in both groups. There were no significant differences between the two groups in transient recurrent laryngeal nerve injury rate, transient hypoparathyroidism rate, volume of drainage, the number of retrieved lymph nodes, hospital stay （ P 〉 0.05）. The postoperative cosmetic scores were much higher in the robotic group （9.4 ± 0.4） than the open group （5.2 ± 1.2） （ P 〈 0.05） . Conclusions The robotic total thyroidectomy and neck lymph node dissection has a similar surgical safety and oncological completeness with open thyroidectomy for papillary thyroid carcinomas with tumor size of 2- 4 cm, and has excellent cosmetic results, suits for patients caring about the neck scars.

关 键 词：达芬奇机器人手术系统 甲状腺癌 甲状腺切除术 手术安全性 肿瘤彻底性 

分 类 号：R736.1[医药卫生—肿瘤]