经口腔前庭入路机器人甲状腺手术30例临床分析  

Preliminary application of transoral robotic thyroidectomy:experience from an initial 30 cases

作　　者：李小磊 贺青卿 李陈钰 王猛 庄大勇 周鹏 岳涛 朱见 徐婧 邵长秀 Li Xiaolei;He Qingqing;Li Chenyu;Wang Meng;Zhuang Dayong;Zhou Peng;Yue Tao;Zhu Jian;Xu Jing;Shao Changxiu(Department of Thyroid and Breast Surgery,the 960th Hospital of People′s Liberation Army,Jinan 250031,China)

机构地区：[1]联勤保障部队第九六〇医院甲状腺乳腺外科,济南250031

出　　处：《中华外科杂志》2021年第12期994-998,共5页Chinese Journal of Surgery

基　　金：国家重点研发计划(2019YFC0119205);国家自然科学基金(81702448);济南市临床医学科技创新计划(202019010);济南军区总医院院长基金(2016ZD02,2017MS04)。

摘　　要：目的探讨经口腔前庭入路机器人甲状腺手术的安全性和有效性。方法回顾性分析联勤保障部队第九六〇医院甲状腺乳腺外科2020年5月至2020年12月连续收治的30例行经口腔前庭入路机器人甲状腺手术患者的临床资料。男性3例,女性27例,年龄(31.5±11.0)岁(范围:17~55岁)。甲状腺良性肿瘤6例,恶性肿瘤24例。观察孔位于下唇系带前方远离牙龈根部1 cm处,第1、2操作孔位于双侧第一前磨牙根部水平靠近唇侧处,分别连接双极马里兰钳和超声刀,第3操作孔位于右侧腋窝皱襞处,连接5 mm精细操作钳。术后1个月采用视觉数字评分系统评估美容效果满意度。结果30例患者均完成手术,无中转开放手术。甲状腺癌患者的病理类型均为甲状腺乳头状癌,肿瘤最大径(5.3±3.0)mm(范围:2~15 mm)。中央区淋巴结清扫数目(10.5±4.4)枚(范围:4~20枚),其中12例中央区淋巴结转移阳性。2例患者术后发生暂时性甲状旁腺功能减退,无永久性甲状旁腺功能减退和喉返神经损伤。其他术后并发症包括血肿1例,感染1例,颏下皮肤穿孔1例,未发生颏神经损伤。术后住院时间(6.3±1.2)d(范围:4~10 d)。经过1~7个月随访,患者未发生局部淋巴结复发或转移。所有患者均对术后美容效果满意,视觉数字评分为(9.4±0.8)分(范围:8.7~9.6分)。结论对于严格筛选的早期甲状腺癌患者,经口腔前庭入路机器人甲状腺手术安全可行,美容效果较好。Objective To examine the surgical outcome of transoral robotic thyroidectomy.Methods Clinic data of total 30 cases of transoral robotic thyroidectomy at the Department of Thyroid and Breast Surgery,the 960th Hospital of People′s Liberation Army from May 2020 to December 2020 were analyzed retrospectively.There were 3 males and 27 females,aged(31.5±11.0)years(range:17 to 55 years),including 6 cases of benign tumor and 24 cases of malignant cancer(all papillary thyroid carcinoma).An inverted U-shaped incision 1.5 cm in length was made over the end of the frenulum of the lower lip.A wide subplatysmal space was created by bluntly passing with a vascular tunneller(8 mm diameter),and a 12 mm trocar was inserted through the lip incision for the camera port.Lateral oral mucosal incisions 8 mm in length were made near both lateral labial commissures,8 mm robot trocars were inserted through the incisions.An 5 mm trocar was inserted through an incision made along the patient′s right axillary fold into the subplatysmal working space and was connected with 5 mm ProGrasp for counter traction during the operation and for later drain insertion.Numerical scoring system(NSS)was used to assess cosmetic effect 1 month post-operation.Results All the 30 transoral robotic thyroidectomies was successful,no case conversed to open operation.Postoperative hospital stay was(6.3±1.2)days(range:4 to 10 days).The tumor size of thyroid cancers was(5.3±3.0)mm(range:2 to 15 mm).Lymph node metastasis was observed in 12 cases.The retrieved central lymph node number was 10.5±4.4(range:4 to 20),while the central metastatic lymph node number was 2(2)(range:1 to 11).Postoperative transient hypoparathyroidism occurred in 2 cases.Permanent hypoparathyroidism and vocal cord palsy didn′t occur.Other surgical complications included hematoma,surgical site infection and perforation of chin flap,retrospectively in 1 case.Local regional lymph node recurrence wasn′t developed during 1 to 7 months follow-up.All patients were satisfied with the postope

关 键 词：甲状腺肿瘤 机器人 甲状腺切除术 经口腔前庭入路 

分 类 号：R653[医药卫生—外科学]