免充气经口腔镜甲状腺癌根治术的临床研究  

Clinical study of gasless transoral endoscopic surgery for thyroid cancer

作　　者：方静 郑绪才 周径 陈公仆 刘松[1] 汤维芳 刘建军[1] 王圣应 FANG Jing;ZHENG Xucai;ZHOU Jing;CHEN Gongpu;LIU Song;TANGWeifang;LIU Jianjun;WANG Shengying(Department of Head and Neck Oncology,West district of the First Affiliated Hospital of University of Science and Technology of China/Anhui Provincial Cancer Hospital,Hefei 230031,China)

机构地区：[1]中国科学技术大学附属第一医院西区/安徽省肿瘤医院头颈肿瘤外科,安徽合肥230031

出　　处：《中国普通外科杂志》2022年第11期1430-1436,共7页China Journal of General Surgery

摘　　要：背景与目的:经口腔镜甲状腺手术由于是经自然腔道手术,体表无疤痕,中央区淋巴结清扫无视野盲区,经临床推广至今,受到广大医生及患者的欢迎。但传统的经口腔镜采用CO_(2)充气的方法维持手术操作空间,空间小,容易产生烟雾,影响视野,且相对于其他入路,经口腔镜更容易出现CO_(2)相关并发症。因此,采用免充气的方法进行手术可能是更好的选择。为此,本中心设计了一种新的方法—经皮悬吊三孔免充气经口腔镜技术进行甲状腺癌手术,经过不断改良后,此项技术趋于成熟。本文通过回顾性分析,探讨此项技术的可行性与安全性,以期为临床决策提供参考。方法:回顾性分析2020年10月—2022年3月在中国科学技术大学附属第一医院西区(安徽省肿瘤医院)头颈肿瘤外科接受免充气经口腔镜甲状腺癌手术患者的临床资料。术中采用自制悬吊拉钩、改良穿刺器进行手术。结果:共纳入106例甲状腺乳头状癌患者,男11例,女95例;平均年龄(35.5±8.1)岁;单侧甲状腺切除91例、甲状腺全切除15例;行中央区淋巴结清扫106例、行侧颈淋巴结择区清扫7例。单纯腔镜甲状腺手术时间(163.9±49.1)min,腔镜甲状腺手术联合侧颈淋巴结清扫时间(331.0±103.9)min。术后中央区淋巴结清扫数(8.6±6.1)枚,单侧侧颈淋巴结清扫数(19.4±7.6)枚。术后住院(5.4±1.4)d。术后一过性发音嘶哑1例、淋巴漏1例,无术后出血、感染、永久性颏神经损伤等并发症发生。结论:免充气经口腔镜技术无CO_(2)相关并发症,采用自制悬吊拉钩可以维持足够的手术操作空间,应用改良的穿刺器减少了器械干扰,增加了腔镜吸引器便于手术操作。Background and Aims:Since transoral endoscopic thyroidectomy is performed via a natural cavity,there is no scar on the body surface,and no blind spots of the visual field in the central neck area.So,it well-accepted by doctors and patients.However,the traditional transoral endoscopic thyroidectomy using CO_(2) inflation to maintain the surgical space has a narrow working cavity with easy smoke generation,which affects the vision.In addition,compared with other approaches,transoral endoscopic thyroidectomy is more prone to CO_(2)-related complications.Therefore,the use of gasless method for endoscopic surgery may be a better choice.For this reason,our center has designed a new method to perform gasless transoral endoscopic thyroidectomy by percutaneous suspension and three-hole endoscopic surgery technique.After continuous improvement,this technique has matured considerably.This paper discusses the feasibility and safety of this technique through a retrospective analysis,so as to provide a reference for clinical decision-making.Methods:The clinical data of patients who underwent non-inflatable transoral endoscopic surgery for thyroid cancer in the Department of Head and Neck Oncology,the First Affiliated Hospital of University of Science and Technology of China(Anhui Cancer Hospital)from October 2020 to March 2022 were retrospectively analyzed.The operation was performed with a self-made suspension retractor and modified trocar.Results:A total of 106 patients with papillary thyroid carcinoma were included.Of the patients,11 cases were males and 95 cases were females with a mean age of(35.5±8.1)years;91 cases underwent unilateral thyroidectomy,and 15 cases underwent total thyroidectomy;106 cases received central lymph node dissection,and 7 cases received selective neck lymph node dissection.The operative time for endoscopic thyroidectomy alone was(163.9±49.1)min,and for endoscopic thyroidectomy combined with lateral neck lymph node dissection was(331.0±103.9)min.The number of resected lymph nodes in the central

关 键 词：甲状腺肿瘤 甲状腺切除术 自然腔道内镜手术 

分 类 号：R736.1[医药卫生—肿瘤]