中国实用外科杂志

中国实用外科杂志

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达芬奇机器人手术治疗甲状腺微小癌150例临床分析

王    猛，郑鲁明，于    芳，董学峰，周    鹏，岳    涛，庄大勇，范子义，等   

  1. 济南军区总医院甲状腺乳腺外科 辽宁医学院济南军区总医院研究生培训基地，山东济南 250031
  • 出版日期:2016-05-01 发布日期:2016-04-28

  • Online:2016-05-01 Published:2016-04-28

摘要：

目的    分析达芬奇机器人手术治疗甲状腺微小乳头状癌（PTMC）病人的临床疗效。方法    回顾性分析2014年2月至2016年1月济南军区总医院甲状腺乳腺外科行机器人手术治疗的150例PTMC病人的临床资料。结果    均行全甲状腺切除术或甲状腺腺叶+峡部切除术及中央区淋巴结清扫。所有手术均顺利完成，无中转开放或腔镜辅助手术。平均手术时间为（139.1±13.1）min，Ⅵ、Ⅲ、Ⅳ区淋巴结转移者分别为61例（40.7%）、8例（5.3%）、3例（2.0%）。平均引流量为（0.2±0.1）L，平均带管时间为（5.5±1.4）d。术后出现暂时性喉返神经损伤3例，暂时性甲状旁腺功能减退19例，术中皮下隧道出血1例，所有病人均未出现永久性喉返神经损伤及甲状旁腺功能减退。随访1～24个月，中位随访时间为11个月，病人对美容效果评价均为非常满意；1例病人出现皮下隧道出血，无复发，无隧道及术区转移种植。结论    达芬奇机器人甲状腺手术安全、可行，且美容效果好，适用于关注颈部美容效果的PTMC病人。

关键词: 达芬奇机器人手术系统, 甲状腺微小乳头状癌, 甲状腺全切除术, 淋巴结清扫

Abstract:

Da Vinci robotic surgical treatment of papillary thyroid carcinoma: A clinical analysis of 150 cases        WANG Meng，ZHENG Lu-ming，YU Fang，et al. Department of Thyroid and Breast Surgery，the General Hospital of Jinan Military Command of PLA，Jinan 250031，China
Corresponding author：HE Qing-qing，E-mail:heqingqing@yeah.net
Abstract    Objective    To explore the technical safety of the operation，the oncology security and the feasibility of clinical application of Da Vinci robotic papillary thyroid microcarcinoma surgery. Methods    The clinical and pathological datas of 150 cases  of PTMC performed da vinci robotic thyroidectomy in the General Hospital of Jinan Military Command of PLA from February 2014 to January 2016 were analyzed retrospectively. The 150 cases underwent total robotic thyroidectomy (or lobectomy and isthmusectomy) and central neck dissection (CND). Result    All the cases of robotic thyroidectomy were completed successfully，and no conversion to open operation. A total of 61 cases (40.7%), 8 cases（5.3%）and 3 cases （2.0%） had level Ⅵ, Ⅲ and Ⅳ lymph nodes metastasis, respectively. The total volume of drainage was（0.2±0.1）L . The time of drainage was （5.5±1.4）days. Transient recurrent laryngeal nerve injury occurred in 3 cases. Transient hypoparathyroidism occurred in 19 cases. Intraoperative subcutaneous tunnel bleeding occurred in 1 case. All the cases had no permanent recurrent laryngeal nerve injury and hypoparathyroidism. All the cases were followed up for 1 to 24 months with the median follow-up time of 11 months. no tumor recurrence. The cosmetic results were satisfactory. The case of subcutaneous tunnel bleeding had no metastasis and recurrence. Conclusion    Da Vinci robotic thyroid surgery is safe，feasible，and with good cosmetic results，suitable for PTMC cases who pay attention to the neck cosmetic effect.

Key words: Da Vinci surgical system, papillary thyroid microcarcinoma, total thyroidectomy, lymph node dissection