舌下前庭入路经口腔镜甲状腺手术:98例临床应用体会  

Clinical experience in transoral endoscopic thyroidectomy via sublingual and vestibular approach: a report of 98 cases

作　　者：罗晔哲[1] 傅艺龙 吴国洋[1] 傅锦波[1] 林素琼[1] 宋正福 陈济宇 严威[1] 旷鹏昊[1] 林恩德[1] 洪晓泉[1] 林福生[1] Luo Yezhe;Fu Yilong;Wu Guoyang;Fu Jinbo;Lin Suqiong;Song Zhengfu;Chen Jiyu;Yan Wei;Kuang Penghao;Lin Ende;Hong Xiaoquan;Lin Fusheng(Department of General Surgery,Zhongshan Hospital,Xiamen University,Xiamen 361004,China)

机构地区：[1]厦门大学附属中山医院普通外科,361004

出　　处：《中华耳鼻咽喉头颈外科杂志》2020年第10期899-904,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨舌下前庭入路经口腔镜甲状腺手术的临床应用。方法回顾性分析2011年11月至2020年5月厦门大学附属中山医院收治的98例舌下前庭入路经口腔镜甲状腺手术患者的病例资料,其中男3例,女95例,年龄18~57岁。根据开展时间段的不同分成2个阶段,阶段A(2011年11月至2015年11月)患者81例,阶段B(2019年8月至2020年5月)患者17例。分析总结2个阶段患者的一般资料、手术时间以及并发症等。应用SPSS 22.0软件进行统计学处理。结果阶段A患者年龄(34.2±9.4)岁,肿瘤直径为(2.33±0.80)cm,术后病理示良性肿瘤76例,恶性肿瘤5例;良性患者的手术时间为(132.70±47.22)min,其中65例行单侧腺叶次全切除术,6例行峡部切除术,5例行双侧腺叶次全切除术;恶性患者的手术时间为(185.4±31.40)min,术式均为单侧腺叶切除术+单侧中央区淋巴清扫术;术后6例出现颈部感染,均经抗感染、引流等处理后好转;出现1例暂时性声带麻痹,术后2个月恢复;出现2例CO2气体栓塞,术中中转开放手术。阶段B患者年龄(35.1±8.5)岁,肿瘤直径为(1.32±0.67)cm,术后病理示良性肿瘤2例,恶性肿瘤15例;良性患者的手术时间为(153.5±34.64)min,均行单侧腺叶切除术;恶性患者的手术时间为(123.73±14.26)min,术式均为单侧腺叶切除术+单侧中央区淋巴清扫术;未出现术后颈部感染、暂时性声带麻痹、CO2气体栓塞。所有患者术后均有不同程度的下颌部皮肤麻木感,为5 mm操作孔相对应的位置,均于术后1~2周恢复正常。2个阶段均未出现术后二次出血、永久性声带麻痹、甲状旁腺功能减退等并发症。阶段A随访时间中位数为86(57~105)个月,阶段B随访时间中位数为5(3~12)个月;随访期间内患者吞咽、咀嚼、口腔感觉功能及颈部活动无明显异常,且无肿瘤复发、转移。结论舌下前庭入路经口腔镜甲状腺手术是安全可行的,具有良好的美容效果。该术式不会引起患Objective To summarize the clinical experience in transoral endoscopic thyroidectomy via sublingual and vestibular approach(TOETSLVA).Methods We retrospectively reviewed the medical record of patients who underwent TOETSLVA in our department from November 2011 to May 2020,including 3 males and 95 females,aged from 18 to 57 years old.Initial 81 cases were categorized in"Period A(November 2011-November 2015)"and subsequent 17 cases in"Period B(August 2019-May 2020)".Data about demographics,operation time and complications were collected.SPSS 22.0 software was used for statistical analysis.Results In Period A,the average age of patients was(34.2±9.4)years old;the mean tumor diameter was(2.33±0.80)cm;postoperative pathology showed benign nodules in 76 cases and malignant carcinoma in 5 cases;there were 65 cases of unilateral subtotal thyroid lobectomy,6 cases of isthmus lobectomy,and 5 cases of bilateral subtotal thyroid lobectomy,with the mean operation time of(132.70±47.22)min;in 5 cases of unilateral thyroid lobectomy with central lymph node dissection,the mean operation time was(185.4±31.40)min;postoperative neck infections occurred in 6 cases;temporary vocal cord paralysis occurred in 1 case,which it recovered within two months;and CO2 gas embolism occurred in 2 cases.In Period B,the average age of patients was(35.1±8.5)years old;mean tumor diameter was(1.32±0.67)cm;postoperative pathology indicated malignant nodules in 15 cases and benign nodules in 2 cases;in 2 cases of unilateral thyroid lobectomy,the mean operation time was(153.5±34.64)min;in 15 cases of unilateral thyroid lobectomy with central lymph node dissection,the mean operation time was(123.73±14.26)min;and none of patients developed postoperative neck infections or CO2 gas embolism.All patients had different degree of cutaneous numbness in the submandibular region after surgery,which recovered within 1-2 weeks.There were no complications such as postoperative secondary hemorrhage,permanent vocal cord paralysis,hypoparathyroidism in both the

关 键 词：甲状腺肿瘤 甲状腺切除术 外科手术 微创性 舌下前庭入路 

分 类 号：R736.1[医药卫生—肿瘤]