机器人甲状腺手术行双侧颈侧区淋巴结区域清扫的临床分析  

Clinical analysis of robotic bilateral modified radical neck dissection through the bilateral axillo-breast approachfor thyroid carcinoma

作　　者：陈岚清 李小磊 庄大勇 周鹏 岳涛 徐婧 陈思娟 李陈钰 邵长秀 贺青卿 Chen Lanqing;Li Xiaolei;Zhuang Dayong;Zhou Peng;Yue Tao;Xu Jing;Chen Sijuan;Li Chenyu;Shao Changxiu;He Qingqing(Department of Thyroid and Breast Surgery,the 96Oth Hospital of the PLA Joint Logistics Support Force,Jinan 250031,China)

机构地区：[1]解放军联勤保障部队第九六○医院甲状腺乳腺外科,济南250031

出　　处：《中华内分泌外科杂志》2024年第1期21-25,共5页Chinese Journal of Endocrine Surgery

基　　金：山东省医药卫生科技发展计划项目(202204011069);济南市临床医学科技创新计划(202328089、202019010);解放军联勤保障部队医学重点学科项目。

摘　　要：目的探讨经双侧胶窝乳晕人路(bilateral axillo-breast approach,BABA)机器人甲状腺手术行双侧颈侧区淋巴结清扫(lymph nodedissection,LND)的安全性和有效性。方法回顾性分析解放军联勤保障部队第九六O医院(原济南军区总医院)甲状腺乳腺外科2014年1月至2023年1月收治的37例甲状腺癌伴双侧颈侧区淋巴结转移(lymph node metastasis,LNM)患者,行经BABA机器人下甲状腺全切+双侧中央区+双侧颈侧区LND的临床资料。女24例,男13例,年龄(33.22±10.53)岁。记录肿瘤直径、中央区和侧区LND个数及转移个数、手术时长、住院天数、并发症、术后美容效果评分等,应用SPSS25.0软件行统计分析,计量资料用均数+标准差(x±s)表示,计数资料用百分比和数字表示。结果37例均顺利完成经BABA机器人下甲状腺全切+双侧中央区+双侧颈侧区LND。病理类型均为甲状腺乳头状癌(papillary thyroid carcino-ma,PTC),肿瘤最大径为(1.47±0.85)cm,中央区LND数目为(19.46±8.84)枚,转移数目为(10.24±5.95)枚;双侧颈侧区LND数目为(38.92±14.21)枚,转移为(7.92±5.84)枚。手术时长为(288.05±77.09)min,住院时间为(10.76±3.92)d,术后住院时间为(8.03±2.08)d。37例均未发生永久性甲状旁腺功能减退(hypoparathyroid-ism,HPT)和永久性喉返神经损伤,且未发生感染、副神经及隔神经损伤。15例术后出现暂时性HPT,1例发生暂时性喉返神经损伤,2例发生乳糜漏。术后1个月美容评分为(9.51±0.69)分。术后随访时间为(27.81±15.10)个月,2例分别于术后10个月、15个月发生颈部淋巴结复发,均再次行经BABA颈部LND,经术后随访,患者均无复发征象。结论对严格挑选的甲状腺癌伴双侧颈侧区LNM的患者行经BABA机器人下双侧颈侧区LND是安全可行,并可取得良好美容效果。Objective To research the efficacy and safety of robotic thyroidectomy and bilateral modified radical neck dissection through bilateral axillo-breast approach(BABA).Methods We retrospectively analyzed the clinical data of 37 patients with thyroid cancer who received bilateral modified radical neck dissection through the BABA at the Department of Thyroid and Breast Surgery of the 96Oth Hospital of the People's Liberation Army from Jan.2014 to Jan.2023.There were 24 females and 13 males,and the average age of the patients was(33,22±10.53)years old.The tumor diameter,number of lymph node dissection and metastasis in the central and lateral re-gions,average operation time,average hospital stay,complications,and aesthetic score were recorded.SPSS 25.0 software was used for statistical analysis,and the measurement data was calculated using mean±standard devia-tion(x+s),and the counting data was expressed in percentages and numbers.Results A total of 37 thyroid cancer patients underwent robotic bilateral regional lymph node dissection.The 37 patients received total thyroidectomy,bilateral central compartment and cervical lateral regional lymph node dissection.All the pathological types were papillary carcinoma,with a maximal tumor diameter of(1.47±0.85)cm.The average number of central lymph nodes dissected was 19.46±8.84,and there were(10.24±5.95)metastases;The average number of lymph nodes removed from the bilateral cervical region was 38.9214.21,and there were(7.92±5.84)metastases.The average op eration time was(288.05±77.09)min,the average length of stay in the hospital was(10.76±3.92)days,and the average length of stay in the hospital following surgery was(8.03±2.08)days.These patients had no permanent hypoparathyroidism,permanent recurrent laryngeal nerve palsy,infection,accessory nerve injury and phrenic nerve injury after operation.Transient hypoparathyroidism occurred in 15 patients,transient recurrent laryngeal nerve palsy occurred in 1 patient,and chyle leak occurred in 2 patients.One month after surg

关 键 词：甲状腺癌 双侧颈侧区淋巴结清扫 机器人手术 双侧腋窝乳晕入路 甲状旁腺功能减退 喉返神经 

分 类 号：R736.1[医药卫生—肿瘤]