中国实用外科杂志

中国实用外科杂志

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经口腔前庭入路腔镜甲状腺全切除术治疗cN0甲状腺乳头状癌临床研究

林仁志1，郑晨辉2a，钟吉俊2b，王    平1，王    勇1   

  1. 1浙江大学医学院附属第二医院甲状腺外科，浙江杭州 310009；2台州市中心医院 a.肿瘤外科  b. 核医学科，浙江台州 318000
  • 出版日期:2020-10-01 发布日期:2020-10-19

  • Online:2020-10-01 Published:2020-10-19

摘要： 目的    探讨经口腔前庭入路腔镜全甲状腺切除术（TOETVA）的有效性及安全性。方法    回顾性分析2017年7月至2019年7月浙江大学医学院附属第二医院甲状腺外科收治的行全甲状腺切除术且病理学检查确诊为甲状腺乳头状癌（PTC）的110例病人的临床资料，术前影像学检查提示无淋巴结转移（cN0）。其中51例行TOETVA（经口组），59例行开放甲状腺手术（开放组），对比两组临床病理学指标、手术效果以及随访情况。结果    两组病人术中喉返神经信号减弱比例、中央区淋巴结清扫数目、单双侧甲状腺清扫比例、淋巴结转移阳性率、阳性淋巴结数目及术后并发症（声音嘶哑、饮水呛咳、暂时性甲状旁腺功能减退及感染）差异均无统计学意义（P＞0.05）。术后随访6个月，经口组与开放组病人的Tg和PTH水平差异无统计学意义（P=0.560、0.206），且均未发现两组有甲状腺残留及甲状腺癌复发转移征象。结论    TOETVA在有效性及安全性方面不劣于开放手术，且体表无手术瘢痕，尤其适合有美容要求的临床低危PTC病人。

关键词: 甲状腺乳头状癌, 经口腔前庭入路, 腔镜甲状腺切除术, 开放甲状腺切除术, 有效性, 安全性

Abstract: Clinical study on the treatment of cN0 papillary thyroid carcinoma by transoral endoscopic thyroidectomy vestibular approach         LIN Ren-zhi*， ZHENG Chen-hui，ZHONG Ji-jun，et al. *Department of Thyroid Surgery，The Second Affiliated Hospital of Zhejiang University School of Medicine，Hangzhou 310009，China
Corresponding author：WANG Yong，E-mail：surgwy@zju.edu.cn
Abstract    Objective    To investigate the effectiveness and safety of transoral endoscopic thyroidectomy vestibular approach (TOETVA). Methods    The clinical-pathological data of 110 patients with papillary thyroid carcinoma (PTC) who underwent total thyroidectomy in Department of Thyroid Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine from July 2017 to July 2019 was analyzed retrospectively. According to postoperative recurrence risk assessments for differentiated thyroid cancer，prcoperative imaging showed no lymph node metastasis(cN0). The subjects were assigned as TOETVA group（n=51） and COT（conventional open thyroidectomy） group（n=59） according to the method of thyroidectomy. The patients’ clinical data，surgical results and follow-up situations between two groups were compared. Results    There were no significant differences between the two groups in number of patients with postoperative recurrent laryngeal nerve signal weakening, the number of central lymph node dissection, the proportion of unilateral and bilateral thyroid dissection, the positive rate of lymph node metastasis, the number of positive lymph nodes and postoperative complications （P>0.05）. There were no significant differences between the two groups in the levels of Tg （P=0.560） and PTH（P=0.206） at 6 months postoperative follow-up. There was neither residues/recurrence of thyroid cancer nor metastasis in either group. Conclusion    The TOETVA group is not inferior to COT group in terms of the effectiveness and safety of thyroidectomy，and there is no surgical scar on the body surface. It is especially suitable for low-risk PTC patients with cosmetic requirements and is worthy of clinical application and promotion.

Key words: papillary thyroid carcinoma, transoral vestibular approach, endoscopic thyroidectomy, open thyroidectomy, effectiveness, security