腋下联合耳后入路达芬奇机器人颈清扫术治疗N1b PTC的初步经验  

Preliminary experience of robotic lateral neck dissection via combined axillary-retroauricular approach for N1b papillary thyroid carcinoma

作　　者：梁发雅[1,2] 韩萍 林沛亮[1,2] 陈仁辉 王静怡 黄晓明[1,2] Liang Faya;Han Ping;Lin Peiliang;Chen Renhui;Wang Jingyi;Huang Xiaoming(Department of Otolaryngology-Head and Neck Surgery,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510280,China;Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation,Guangzhou 510280,China)

机构地区：[1]中山大学孙逸仙纪念医院耳鼻咽喉科,广州510280 [2]广东省恶性肿瘤表观遗传与基因调控重点实验室,广州510280

出　　处：《中华耳鼻咽喉头颈外科杂志》2022年第9期1072-1078,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的评价腋下联合耳后入路达芬奇机器人颈清扫术治疗N1b甲状腺乳头状癌(PTC)的可行性、安全性及近期疗效。方法回顾性分析2016年12月至2020年12月中山大学孙逸仙纪念医院耳鼻咽喉科收治并行腋下联合耳后入路达芬奇机器人手术的30例cT1-2N1bM0 PTC患者,其中男性10例,女性20例,中位年龄34.5岁,体质量指数(BMI)中位数为25.55 kg/m^(2)。分析患者的手术、并发症、病理及随访等资料,采用SPSS 25.0进行数据分析。结果30例患者中位手术时间为255.50 min,中位手术出血量为69.00 ml,中位术后住院时间为6.00 d。术后暂时性喉返神经麻痹发生率为3.33%(1/30),暂时性甲状旁腺功能低下发生率为16.67%(5/30),暂时性副神经损伤发生率为3.33%(1/30),血肿发生率为3.33%(1/30),乳糜漏发生率为3.33%(1/30),无永久性并发症发生。术后3个月中位美观效果视觉模拟量表(VAS)评分为8.00分。随访时间13~38个月,中位时间为25.5个月,1例患者于术后14个月出现颈侧区淋巴结复发,21例(70.00%)患者末次随访的动态复发危险度分层显示良好。结论腋下联合耳后入路达芬奇机器人颈清扫术治疗N1b PTC安全、可行,近期疗效满意,且术后美观效果佳,可以为N1b PTC患者提供一种术式选择。Objective To evaluate the feasibility,safety,and short-term efficacy of robotic lateral neck dissection via combined axillary-retroauricular approach for N1b papillary thyroid carcinoma(PTC).Methods Thirty patients with cT1-2N1bM0 PTC who received robotic lateral neck dissection via combined axillary-retroauricular approach were included in the Department of Otorhinolaryngology of Sun Yat-sen Memorial Hospital from December 2016 to December 2020.There were 10 males and 20 females,with a median age of 34.5 years and a median body mass index of 25.55 kg/m^(2).The clinical,surgical,complications,pathology and follow-up data were analysed with SPSS 25.0 software package.Results The median operative time of 30 patients was 255.50 min,the median operative blood loss was 69.00 ml,and the median postoperative hospital stay was 6.00 days.The incidence of postoperative temporary recurrent laryngeal nerve paralysis was 3.33%(1/30),temporary hypoparathyroidism was 16.67%(5/30),temporary accessory nerve injury was 3.33%(1/30),hematoma was 3.33%(1/30)and chylous leakage was 3.33%(1/30).The median visual analogue scale(VAS)score was 8.00,and the follow-up time was 13-38 months,with a median of 25.5 months.One case showed cervical lymph node recurrence 14 months after surgery.The most recent dynamic recurrence risk stratification showed 21 patients(70.00%)had excellent responses.Conclusions Robotic lateral neck dissection via combined axillary-retroauricular approach for unilateral cN1b PTC is safe,feasible and aesthetic.The short-term efficacy and dynamic recurrence risk stratification results of short-term follow-up are satisfactory.It can provide a surgical option for cN1b PTC patients.

关 键 词：甲状腺肿瘤 机器人手术 腋下入路 耳后入路 

分 类 号：R736.1[医药卫生—肿瘤]