经口腔前庭入路腔镜甲状腺癌根治手术的临床体会
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摘要
目的探讨经口腔前庭入路腔镜甲状腺癌根治术临床应用的可行性及安全性。方法查询我院实施经口腔前庭入路腔镜甲状腺癌根治手术的临床资料,包括一般资料、手术方式、手术时间、出血量、并发症、住院时间、手术转归和术后病理结果等指标,综合分析该术式的可行性及安全性。结果 2016年11月～2018年11月我科共实施经口腔前庭入路腔镜甲状腺癌根治手术36例,其中女性27例,男性9例,中位年龄27岁(22～32岁);所有患者均成功实施口腔前庭入路甲状腺癌根治手术(甲状腺腺叶及峡部切除+患侧中央区淋巴结清扫术),无中转病例;平均手术时间150 min(120～180 min);术中平均出血量35 mL(20～75mL);术后均无伤口感染、出血、声音嘶哑、饮水呛咳、手足抽搐等并发症发生;1例术中刺穿颏下皮肤,所有病例术后均出现不同程度的口唇和颏下肿胀,术后7天均基本消退;术后病理结果 36例均为甲状腺乳头状癌,中央区淋巴结平均数目5.5枚(3～11枚);术后3个月复查体表及口腔前庭均无疤痕,患者对美容效果满意。结论选择合适的病例行经口腔前庭入路腔镜甲状腺癌根治术安全可行,在美容效果和中央区淋巴结清扫彻底性上有优势。
Objective To investigate the feasibility and safety of endoscopic thyroidectomy via oral vestibular approach for thyroid cancer.Methods The clinical data of endoscopic thyroidectomy via oral vestibular approach were analyzed retrospective,including basic information of patients,operation procedures,operation time,bleeding volume,complications,hospital stay,and pathological results.Results From November 2016 to November 2018,36 patients underwent endoscopic thyroidectomy via oral vestibular approach,including 27 females and 9 males,with a median age of 27 years(22-32 years).All patients were successfully treated withradical thyroidectomy via oral vestibular approach(thyroidectomy and isthmus+lymphadenectomy of central region of affected side),with an average operation time of 150 min(120-180 min).The average amount of bleeding during operation was 35 ml(20-75 ml),and no complications were found,such as wound infection,bleeding,hoarseness,drinking cough,hand-foot twitching after operation.One case was punctured the submental skin during operation.All cases had different degrees of swelling of the lips and chin after operation,and disappeared after7 days.Pathological results showed that 36 cases were papillary thyroid cancer.The average number of lymph nodes was 5.5(3-11);there were no scars on the body surface and oral vestibule 3 months after operation,and the patients were satisfied with the cosmetic effect.Conclusion Endoscopic thyroidectomy via oral vestibular approach is safe and feasible in selecting suitable cases.It has advantages in cosmetic effect and thorough lymph node dissection in central region.
Objective To investigate the feasibility and safety of endoscopic thyroidectomy via oral vestibular approach for thyroid cancer.Methods The clinical data of endoscopic thyroidectomy via oral vestibular approach were analyzed retrospective,including basic information of patients,operation procedures,operation time,bleeding volume,complications,hospital stay,and pathological results.Results From November 2016 to November 2018,36 patients underwent endoscopic thyroidectomy via oral vestibular approach,including 27 females and 9 males,with a median age of 27 years(22-32 years).All patients were successfully treated withradical thyroidectomy via oral vestibular approach(thyroidectomy and isthmus+lymphadenectomy of central region of affected side),with an average operation time of 150 min(120-180 min).The average amount of bleeding during operation was 35 ml(20-75 ml),and no complications were found,such as wound infection,bleeding,hoarseness,drinking cough,hand-foot twitching after operation.One case was punctured the submental skin during operation.All cases had different degrees of swelling of the lips and chin after operation,and disappeared after7 days.Pathological results showed that 36 cases were papillary thyroid cancer.The average number of lymph nodes was 5.5(3-11);there were no scars on the body surface and oral vestibule 3 months after operation,and the patients were satisfied with the cosmetic effect.Conclusion Endoscopic thyroidectomy via oral vestibular approach is safe and feasible in selecting suitable cases.It has advantages in cosmetic effect and thorough lymph node dissection in central region.
引文
[1]Jongekkasit I,Jitpratoom P,Sasanakietkul T,et al.Transoral endoscopic thyroidectomy for thyroid cancer[J].Endocrinol Metab Clin North Am,2019,48(1):165-180.
[2]Camenzuli C,Schembri Wismayer P,Calleja Agius J.Transoral endoscopic thyroidectomy:a systematic review of the practice so far[J].JSLS,2018,22(3).
[3]Benhidjeb T,Wilhelm T,Harlaar J,et al.Natural orifice surgery on thyroid gland:totally transoral video-assisted thyroidectomy(TOVAT):report of first experimental results of a new surgical method[J].Surg Endosc,2009,23(5):1119-1120.
[4]王存川,翟贺宁,刘卫军,等.经口腔前庭腔镜甲状腺切除术6例经验[J].中国内镜杂志,2013,19(4):363-366.
[5]Wilhelm T,Metzig A.Endoscopic minimally invasive thyroidectomy:first clinical experience[J]2010,24(7):1757-1758.
[6]惠栓,张立.经口腔前庭入路腔镜与开放甲状腺切除术的临床研究[J].岭南现代临床外科,2018,18(6):615-607.
[7]Jongekkasit I,Jitpratoom P,Sasanakietkul T,et al.Transoral endoscopic thyroidectomy for thyroid cancer[J].Endocrinol Metab Clin North Am,2019,48(1):165-180.
[8]Shan L,Liu J.A systemic review of transoral thyroidectomy[J].Surg Laparosc Endosc Percutan Tech,2018,28(3):135-138.
[9]丁晖,孙鹏,潘运龙,等.经口腔前庭入路与完全乳晕入路腔镜甲状腺手术的对比研究[J].腹腔镜外科杂志,2017,22(4):249-252.
[10]王勇,谢秋萍,俞星,等.经口腔前庭入路腔镜甲状腺手术150例临床分析[J].中华外科杂志,2017,55(8):587-591.
[11]王松,代文杰.完全经口腔镜甲状腺切除术的研究进展[J].中华外科杂志,2013,51(3):276-278.
[12]Razavi CR,Vasiliou E,Tufano RP,Russell JO.Learning curve for transoral endoscopic thyroid lobectomy[J].Otolaryngol Head Neck Surg,2018,159(4):625-629.
[13]王平,吴国洋,田文,等.经口腔前庭入路腔镜甲状腺手术专家共识(2018版)[J].中国实用外科杂志,2018,38(10):21-24.2019-04-05
[2]Camenzuli C,Schembri Wismayer P,Calleja Agius J.Transoral endoscopic thyroidectomy:a systematic review of the practice so far[J].JSLS,2018,22(3).
[3]Benhidjeb T,Wilhelm T,Harlaar J,et al.Natural orifice surgery on thyroid gland:totally transoral video-assisted thyroidectomy(TOVAT):report of first experimental results of a new surgical method[J].Surg Endosc,2009,23(5):1119-1120.
[4]王存川,翟贺宁,刘卫军,等.经口腔前庭腔镜甲状腺切除术6例经验[J].中国内镜杂志,2013,19(4):363-366.
[5]Wilhelm T,Metzig A.Endoscopic minimally invasive thyroidectomy:first clinical experience[J]2010,24(7):1757-1758.
[6]惠栓,张立.经口腔前庭入路腔镜与开放甲状腺切除术的临床研究[J].岭南现代临床外科,2018,18(6):615-607.
[7]Jongekkasit I,Jitpratoom P,Sasanakietkul T,et al.Transoral endoscopic thyroidectomy for thyroid cancer[J].Endocrinol Metab Clin North Am,2019,48(1):165-180.
[8]Shan L,Liu J.A systemic review of transoral thyroidectomy[J].Surg Laparosc Endosc Percutan Tech,2018,28(3):135-138.
[9]丁晖,孙鹏,潘运龙,等.经口腔前庭入路与完全乳晕入路腔镜甲状腺手术的对比研究[J].腹腔镜外科杂志,2017,22(4):249-252.
[10]王勇,谢秋萍,俞星,等.经口腔前庭入路腔镜甲状腺手术150例临床分析[J].中华外科杂志,2017,55(8):587-591.
[11]王松,代文杰.完全经口腔镜甲状腺切除术的研究进展[J].中华外科杂志,2013,51(3):276-278.
[12]Razavi CR,Vasiliou E,Tufano RP,Russell JO.Learning curve for transoral endoscopic thyroid lobectomy[J].Otolaryngol Head Neck Surg,2018,159(4):625-629.
[13]王平,吴国洋,田文,等.经口腔前庭入路腔镜甲状腺手术专家共识(2018版)[J].中国实用外科杂志,2018,38(10):21-24.2019-04-05