经口腔前庭入路腔镜甲状腺手术的临床效果分析  

Clinical Experience on Transoral Endoscopic Thyroidectomy Vestibular Approach

作　　者：王鹏辉 冯国勋[1] 俞巍[1] 张洪义 WANG Penghui;FENG Guoxun;YU Wei;ZHANG Hongyi(Department of General Surgery,Beijing Tiantan Hospital Affiliated to Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院普通外科,北京100070

出　　处：《河南医学研究》2023年第3期447-451,共5页Henan Medical Research

摘　　要：目的 探讨经口腔前庭入路腔镜甲状腺手术(TOETVA)治疗甲状腺良、恶性结节等的效果及安全性。方法 回顾性分析2019年10月至2022年1月首都医科大学附属北京天坛医院收治的62例接受甲状腺手术患者的临床资料,观察手术并发症、术后疼痛评分及美容满意度评分。结果 61例患者完成TOETVA,1例患者因术中甲状腺质脆,术中出血量较大,被迫中转开放手术。甲状腺部分切除术3例,甲状腺次全切除术7例,甲状腺腺叶、峡部和中央组淋巴结清扫术43例,甲状腺全切和双侧中央组淋巴结清扫术9例。术后病理报告提示结节性甲状腺7例,甲状腺腺瘤3例,甲状腺滤泡状癌1例,甲状腺乳头状癌51例。术后24 h疼痛评分中位数为2分。术后出院时美容评分中位数为9分。甲状腺乳头状癌最大径0.70(0.50,1.00) cm,住院治疗费用(20 796.69±4 209.92)元,住院时间6.00(5.00,8.00)d。暂时性喉返神经损伤1例(1.6%),暂时性甲状旁腺功能低下5例(8.1%)。无永久性喉返神经损伤及甲状旁腺功能低下、喉上神经损伤、感染、淋巴瘘、霍纳综合征、暂时性面神经下颌缘支分支损伤情况发生,术后出现皮肤烧伤1例(1.6%)。2例(3.2%)患者出现颏神经损伤,表现为持续性的一侧下唇及下颌区麻木感觉,随访3个月后明显改善。无口腔切口感染、血肿积液、声音嘶哑、饮水呛咳等并发症发生。使用Spearman和Pearson相关分析各指标的相关性,结果显示,住院时间与术后第1、2天引流量均呈反比(r=-0.351、-0.284,P<0.05);花费与住院时间呈正比(r=0.350,P<0.05)。结论 TOETVA的手术并发症较少,术后疼痛评分较低,患者耐受性良好,可达到满意的美容效果,手术安全有效。相关性分析表明,保持伤口引流管通畅有利于降低患者住院时间和费用。Objective To investigate the safety and efficacy of transoral endoscopic thyroidectomy vestibular approach(TOETVA) in the treatment of benign and malignant thyroid nodules.Methods The clinical data of 62 patients undergoing thyroid surgery admitted to Beijing Tiantan Hospital Affiliated to Capital Medical University from October 2019 to January 2022 were retrospectively analyzed, and the surgical complications, postoperative pain scores and cosmetic satisfaction scores were observed.Results A total of 61 patients completed TOETVA, and 1 patient was forced to switch to open surgery due to fragile thyroid and large intraoperative hemorrhage. Partial thyroidectomy was performed in 3 cases, subtotal thyroidectomy in 7 cases, thyroid lobectomy, isthmus and central group lymphadenectomy in 43 cases, total thyroidectomy and bilateral central group lymphadenectomy in 9 cases. Postoperative pathological report showed that there were 7 cases of nodular thyroid, 3 cases of thyroid adenoma, 1 case of thyroid follicular carcinoma and 51 cases of thyroid papillary carcinoma. The median pain score at 24 hours after operation was 2. The median beauty score at discharge after surgery was 9. The maximum diameter of thyroid papillary carcinoma was 0.70(0.50, 1.00) cm, the hospitalization cost was(20 796.69±4 209.92) yuan, and the hospitalization time was 6.00(5.00, 8.00) days. Temporary recurrent laryngeal nerve injure was found in 1 case(1.6%) and temporary hypoparathyroidism in 5 cases(8.1%). There was no permanent recurrent laryngeal nerve injury, hypoparathyroidism, superior laryngeal nerve injury, infection, lymphatic fistula, Horner’s syndrome, and temporary injury of mandibular marginal branch of facial nerve. Skin burn occurred in 1 case(1.6%) after operation. Two patients(3.2%) suffered from mental nerve injury, which showed persistent numbness in the lower lip and mandibular region, and improved significantly after 3 months of follow-up. There were no complications such as oral incision infection, hematoma and fluid ac

关 键 词：腔镜甲状腺手术 口腔前庭入路 美容 微创 

分 类 号：R583.1[医药卫生—内分泌]