经颏下口腔前庭联合腋窝入路内镜甲状腺手术6例报告  

Submental and axillary channel-assisted transoral endoscopic thyroidectomy vestibular approach:a report of 6 cases

作　　者：陶龙[1] 阮剑[1] TAO Long;RUAN Jian(Department of Breast and Thyroid Surgery,Wuhan First Hospital,Wuhan 430030,China)

机构地区：[1]湖北省武汉市第一医院甲乳外科,湖北武汉430030

出　　处：《中国普通外科杂志》2024年第5期788-795,共8页China Journal of General Surgery

摘　　要：背景与目的:近年来,各种颈部无痕的甲状腺手术逐渐成熟,经口腔前庭入路全内镜甲状腺手术(TOETVA)由于其路径短、清扫淋巴结方便彻底、体表无痕,逐渐受到医生及患者的青睐。然而,在笔者团队前期开展的TOETVA患者中发现,部分术后有不同程度的颏部麻木感、下唇运动功能减退、水肿变形、颏部瘢痕增生变硬等不适,于是团队后期采用5 mm内镜进行经口腔甲状腺手术,并加入腋窝通道辅助手术和取出标本,即经口腔联合腋窝入路全内镜甲状腺手术(AcaTOETVA),当面对颏骨过于突出的患者,口腔观察孔隧道比较难建立时,采用颏下5 mm切口建立观察孔隧道,行经颏下口腔前庭联合腋窝入路内镜甲状腺手术(SaAcaTOETVA)。本文通过总结行该术式的有限病例,初步探讨该术式的可行性及优缺点。方法:回顾性分析6例武汉市第一医院甲乳外科2020年9月—11月完成SaAcaTOETVA患者的临床资料。结果:6例患者均顺利完成手术,其中3例行甲状腺左侧腺叶切除术+左侧中央区淋巴结清扫,1例行甲状腺右侧腺叶切除术+右侧中央区淋巴结清扫,1例行甲状腺右侧腺叶近全切除术,1例行甲状腺双侧叶近全切除术,手术时间100~155 min,术中出血量10~20 mL,术后住院时间3 d,患者无喉返神经损伤,无皮下血肿、颏神经损伤、颏部及嘴唇麻木、颏部肿胀、低钙血症、吞咽困难、CO_(2)气体栓塞、切口感染延迟愈合等并发症发生,1例患者出现颏部小范围瘀青,为操作孔穿刺所致,于1周内恢复。术后1个月随访,患者颏下切口愈合良好,正常站立位时,切口隐藏于颏下及腋窝,相对隐蔽不易被发现,患者对颏下及腋窝切口满意,术后复查未发现肿瘤种植、复发或转移。结论:采用SaAcaTOETVA安全可行,是AcaTOETVA的特殊情况的重要补充,具有切口较隐蔽、美观的特点,但5 mm内镜的清晰度问题以及初始建腔空间较小的问题,可能会影�Background and Aims:Various neck scarless surgeries have gradually matured in recent years.Transoral endoscopic thyroidectomy via vestibular approach(TOETVA)has gained popularity among doctors and patients due to its shorter path,convenient and thorough lymph node dissection,and absence of visible scars.However,in the initial TOETVA cases the authors'team performed,some patients experienced varying degrees of chin numbness,reduced lower lip mobility,swelling and deformation,and hardening of chin scars after operation.Therefore,the team adopted a 5 mm endoscope for transoral thyroid surgery,supplemented by an axillary approach for assistance and specimen retrieval.This combined method is termed the axillary channel-assisted transoral endoscopic thyroidectomy vestibular approach(AcaTOETVA).For patients with a prominent chin bone,where establishing the oral observation channel is difficult,a 5 mm submental incision is made to create the observation channel to perform submental and axillary channel-assisted transoral endoscopic thyroidectomy vestibular approach(SaAcaTOETVA).This paper summarizes the limited cases of this surgical method to explore its feasibility,advantages,and disadvantages preliminarily.Methods:The clinical data of 6 patients who underwent SaAcaTOETVA in the Breast and Thyroid Surgery Department of Wuhan First Hospital from September to November 2020 were retrospectively analyzed.Results:All 6 patients completed the surgery.Among them,3 patients underwent left thyroid lobectomy with left central lymph node dissection,1 patient underwent right thyroid lobectomy with right central lymph node dissection,1 patient underwent near-total right thyroid lobectomy,and 1 patient underwent near-total bilateral thyroid lobectomy.The surgery duration ranged from 100 to 155 min,intraoperative blood loss was 10 to 20 mL,and the postoperative hospital stay was 3 d.No patients experienced recurrent laryngeal nerve injury,subcutaneous hematoma,chin nerve injury,chin and lip numbness,chin swelling,hypocalcemia,swallow

关 键 词：甲状腺肿瘤 甲状腺切除术 内窥镜 经口腔入路 

分 类 号：R736.1[医药卫生—肿瘤]