免注气经下唇前庭入路机器人甲状腺手术初步经验

Preliminary experience of gasless transoral vestibular robotic thyroidectomy

甲状腺切除术免注气机器人手术经口入路ThyroidectomyGaslessRobotic surgeryTransoral approach

目的:探讨采用丝线悬吊方法进行免注气经下唇前庭入路机器人甲状腺手术的可行性及安全性。方法:回顾性分析2022年2月至5月中山大学孙逸仙纪念医院耳鼻咽喉科行免注气经下唇前庭入路机器人甲状腺手术的20例患者的临床资料，其中女性18例，男性2例，年龄为（38.7±8.0）岁。记录手术时间、术中出血量、术后住院时间、术后疼痛视觉模拟量表（VAS）评分、术后吞咽障碍评分（swallowing impairment score-6，SIS-6）、术后美观VAS评分、术后嗓音障碍指数（voice handicap index-10，VHI-10）、术后病理及并发症情况等。采用SPSS 25.0软件对数据进行统计分析。结果:患者均顺利完成手术，无中转开放。18例病理为甲状腺乳头状癌，1例为胸骨后结节性甲状腺肿，1例为甲状腺肿伴囊性变。甲状腺癌手术时间为161.50（152.75，182.50）min［ M（ P25， P75），下同］，甲状腺良性疾病的平均手术时间为166.50 min；手术出血量为25.00（21.25，30.00）ml。18例甲状腺癌肿瘤直径为（7.22±2.02）mm，中央区清扫（6.56±2.14）个淋巴结，中央区淋巴结转移率为61.11%。术后24 h疼痛VAS评分为3.00（2.25，4.00）分，术后引流量为（118.35±24.32）ml，术后住院天数为3.00（3.00，3.75）d，术后3个月SIS-6评分为（4.90±1.58）分，术后3个月VHI-10为7.50（2.00，11.00）分。术后3个月7例患者有轻度下颌麻木感，10例有轻度颈部麻木感，3例暂时性甲状旁腺功能低下；1例皮瓣灼伤，并在术后1个月恢复；所有患者均对术后美观效果满意，术后美观VAS评分为10.00（10.00，10.00）分。 结论:采用悬吊法进行免注气经下唇前庭入路机器人甲状腺手术安全、可行，术后美观效果好，可为部分经选择的甲状腺肿瘤患者提供新的治疗选择。

Objective:To explore the feasibility and safety of the gasless transoral vestibular robotic thyroidectomy using skin suspension.Methods:The clinical data of 20 patients underwent gasless transoral vestibular robotic thyroidectomy in the Department of Otorhinolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University from February 2022 to May 2022 were retrospectively analyzed. Among them, 18 were females and 2 were males, aged (38.7±8.0) years old. The intraoperative blood loss, operation time, postoperative hospital stay, postoperative drainage volume, postoperative pain visual analogue scale (VAS) score, postoperative swallowing function swallowing impairment score-6 (SIS-6), postoperative aesthetic VAS score, postoperative voice handicap index-10 (VHI-10) voice quality, postoperative pathology and complications were recorded. SPSS 25.0 was used for statistical analysis of the data.Results:The operations were successfully completed without conversion to open surgery in all patients. Pathological examination showed papillary thyroid carcinoma in 18 cases, retrosternal nodular goiter in 1 case, and cystic change in goiter in 1 case. The operative time for thyroid cancer was 161.50 (152.75, 182.50) min ” M ( P25, P75), the same below” and the average operative time for benign thyroid diseases was 166.50 minutes. The intraoperative blood loss 25.00 (21.25, 30.00) ml. In 18 cases of thyroid cancer, the mean diameter of the tumors was (7.22±2.02) mm, and lymph nodes (6.56±2.14) were dissected in the central region, with a lymph node metastasis rate of 61.11%. The postoperative pain VAS score was 3.00 (2.25, 4.00) points at 24 hours, the mean postoperative drainage volume was (118.35±24.32) ml, the postoperative hospital stay was 3.00 (3.00, 3.75) days, the postoperative SIS-6 score was (4.90±1.58) points at 3 months, and the postoperative VHI-10 score was 7.50 (2.00, 11.00) points at 3 months. Seven patients had mild mandibular numbness, 10 patients had mild cervical numbness, and 3 patients had temporary hypothyroidism three months after surgery and 1 patient had skin flap burn, but recovered one month after surgery. All patients were satisfied with the postoperative aesthetic effects, and the postoperative aesthetic VAS score was 10.00 (10.00, 10.00). Conclusion:Gasless transoral vestibular robotic thyroidectomy using skin suspension is a safe and feasible option with good postoperative aesthetic effect, which can provide a new treatment option for some selected patients with thyroid tumors.

中华耳鼻咽喉头颈外科杂志

广州地区临床重大技术项目(2023P-ZD13)

Guangzhou Health Science and Technology Project(2023P-ZD13)

2023-06-07

期刊论文

https://wf.pub/perios/article:10.3760/cma.j.cn115330-20221108-00672doi

10.3760/cma.j.cn115330-20221108-00672doi

zhebyhk202306009

zh

万方数据库

CMA