改良无充气经锁骨下入路腔镜甲状腺手术治疗甲状腺乳头状癌70例疗效分析  

Modified gasless trans-subclavian approach endoscopic thyroidectomy for papillary thyroid carcinoma: a series of 70 cases

作　　者：章德广[1] 何高飞[1] 李建波 褚俊杰 陆晓筱 姜金汐 高力[1] ZHANG De-guang;HE Gao-fei;LI Jian-bo(Department of Head and Neck Surgery,Sir Run Run Shaw Hospital,Medical School,Zhejiang University,Hangzhou 310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院头颈外科,浙江杭州310016

出　　处：《中国实用外科杂志》2022年第6期691-694,699,共5页Chinese Journal of Practical Surgery

摘　　要：目的 探讨改良无充气经锁骨下入路腔镜甲状腺手术治疗甲状腺乳头状癌的可行性和安全性。方法 回顾性分析2021年1~7月在浙江大学医学院附属邵逸夫医院头颈外科接受改良无充气经锁骨下入路腔镜甲状腺手术的70例甲状腺乳头状癌病人的临床资料。记录手术时间、中央区完全显露率、住院时间、清扫淋巴结数目及术后并发症。采用门诊随访方式,随访截止时间为2022年1月。结果 所有病例均顺利在腔镜下完成手术,无中转开放手术。甲状腺乳头状癌最大直径为6(2~30)mm,中央区淋巴结获取数目为4(0~19)枚。中央区完全显露率为92.8%(65/70)。手术时间为95(65~145)min,术后住院时间为4(2~5)d。暂时性喉返神经损伤1例,皮下积液1例,局部红肿2例,均经保守治疗痊愈。无术后出血发生。随访过程中无肿瘤残留或复发。结论 改良无充气经锁骨下入路腔镜甲状腺手术治疗甲状腺乳头状癌安全可行,中央区淋巴结清扫彻底,切口隐蔽性好,有临床运用价值。Objective To investigate the safety and feasibility of modified gasless trans-subclavian approach endoscopic thyroidectomy for papillary thyroid carcinoma(PTC). Methods The clinical data of consecutive 70 patients with PTC who underwent the modified gasless trans-subclavian approach endoscopic thyroidectomy in the Head and Neck Surgery Department of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from January 2021 to July 2021 were retrospectively analyzed. The operation time, the complete exposure rate of the central compartment, the length of postoperative hospital stay, the number of central compartment lymph nodes dissected and the postoperative complications were recorded. The patients were followed up by outpatient review and until January 2022. Results All operations were successfully completed under endoscopy approach without transfer to open surgery. The maximum diameter of PTC was 6 mm(range: 2-30 mm), and the number of lymph nodes in the central compartment was 4(range:0-19). The total exposure rate of the central compartment was 92.8%(65/70). The operation time was 95 min(range: 65to 145 min), and the postoperative hospital stay was 4 days(range: 2 to 5 days). One transient recurrent laryngeal nerve injury was observed. One seroma and two local redness and swelling were observed, which were cured after conservative treatment. No postoperative bleeding was observed. No local residue or recurrence was observed during postoperative follow-up. Conclusion The modified gasless trans-subclavian approach endoscopic thyroidectomy is a feasible approach in PTC patients, the lymph nodes in the central compartment are thoroughly dissected, the incision is well concealed, and has clinical application value.

关 键 词：腔镜 甲状腺乳头状癌 经锁骨下入路 甲状腺切除术 

分 类 号：R6[医药卫生—外科学]