经口入路腔镜手术在较大甲状腺良性肿瘤中的应用

彭文; 彭小伟; 李赞; 李慧; 周晓; 宋达疆; 周波; 吕春柳; 伍鹏; 欧延

doi:10.13201/j.issn.1001-1781.2018.13.003

经口入路腔镜手术在较大甲状腺良性肿瘤中的应用

- 湖南省肿瘤医院(中南大学湘雅医学院附属肿瘤医院)肿瘤整形/头颈外科(长沙, 410006)
基金项目:
湖南省自然科学基金（No：2016JJ6089）；湖南省肿瘤整形外科临床医疗技术研究中心（No：2013TP4087）；国家癌症中心肿瘤科研专项（No：WCC2017A15）

详细信息

通讯作者: 彭小伟,E-mail:xiaoweipeng619@163.com

中图分类号: R739.6

收稿日期: 2018-04-05

Application of transoral endoscopic thyroidectomy for benign thyroid nodule

- Department of Oncology Plastic Surgery/Head and Neck Surgery, Hunan Cancer Hospital, the Affiliated Tumor Hospital of Xiangya Medical School, Central South University, Changsha, 410006, China

More Information

Corresponding author: PENG Xiaowei, E-mail: xiaoweipeng619@163.com

Received Date: 05 April 2018

摘要

摘要: 目的：探讨经口入路腔镜甲状腺手术在治疗甲状腺良性肿瘤中的应用价值和可行性。方法：2016-07-2017-12期间对符合入组标准的76例甲状腺良性肿瘤患者进行手术治疗。其中采用经口腔前庭入路腔镜甲状腺手术31例（腔镜组），同期行传统开放手术45例为对照组。观察指标为肿物大小、术式、并发症、手术时间、出血量、引流量及术后住院时间。结果：2组在年龄、性别、瘤体大小、术式等方面相匹配，2组病理结果均显示为良性病变。引流量、术后住院时间及并发症的发生率经比较差异无统计学意义。腔镜组：1例患者出现暂时性喉返神经损伤，3个月后恢复，无永久性喉返神经损伤；1例患者出现术后积液；1例颈部皮下气肿；1例出现鼻插管一侧鼻翼的皮肤压伤，1周后结痂痊愈。对照组：无永久性声带麻痹，1例出现暂时性喉返神经损伤，3个月后恢复；1例术后伤口感染；1例出现术后积液；1例术后8 h出现颈部血肿，考虑为术后出血，再次入手术室进行止血后痊愈。腔镜手术的平均出血量为（20±4）ml，手术时间为（107±11）min，与传统手术组相比差异有统计学意义。结论：经口入路腔镜甲状腺手术治疗甲状腺良性肿块安全、有效，对于有美容需求的患者是一种较好的选择。
- 甲状腺切除术 /
- 经口入路 /
- 内镜术 /
- 颏神经
Abstract: Objective: To evaluate the feasibility and application value of transoral endoscopic thyroidectomy for benign thyroid nodule.Method: Thirty-one patients with benign thyroid tumors underwent transoral endoscopic thyroidectomy via oral vestibular approach at our hospital between July 2016 and December 2017. Forty-five patients were enrolled as control group by conventional approach.Two groups were compared with regards to tumor size,types of operation, operation time, bleeding, volume of drainage, complication and postoperative hospital stay.Result: Pathology examinations proved benign in both groups.Two groups were matched by age, sex, tumor size and types of operation. No statistical significance was found in volume of drainage, postoperative hospital stay and complication. Endoscopic group:no permanent glottic paralysis;one patient had transient hoarseness and recovered after 3 months. In one case,subcutaneous seroma was noted.One patient suffered from cervical subcutaneous emphysema. One patient had a epidermal damage of the ala nasi on the side of the nasal intubation, and recovered after one week. no permanent glottic paralysis;One patient had transient hoarseness and recovered after 3 months. No local infection at the incision site or within the cervical spaces occurred. No mental nerve palsy was observed. Control group:one patients occurred transient hoarseness and recovered after 3 months. No permanent recurrent nerve paralysis occurred; one patient suffered from local infection; one patient had subcutaneous seroma; one cases of postoperative hematoma occurred after 8 hours later. The average blood loss of endoscopic surgery was (20±4) ml, and the mean of operation time was (107±11) min. The difference was statistically significant between the endoscopic surgery and the conventional surgery.Conclusion: The novel transoral endoscopic thyroidectomy is feasible and safe,and it may be a good choice for patients with beauty needs.
- thyroidectomy /
- transoral /
- endoscopy /
- mental nerve

HTML全文

参考文献(11)

[1]	刘超, 蒋须勤.良性结节性甲状腺疾病的治疗进展[J].国外医学:内分泌学分册, 2001, 21(2):68-70.
[2]	WANG C, ZHAI H, LIU W, et al.Thyroidectomy:a novel endoscopic oral vestibular approach[J].Surgery, 2014, 155:33-38.
[3]	ANUWONG A, KETWONG K, JITPRATOOM P, et al.Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach[J].JAMA Surg, 2018, 153:21-27.
[4]	PARK J O, SUN D I.Transoral endoscopic thyroidectomy:our initial experience using a new endoscopic technique[J].Surg Endosc, 2017, 31:5436-5443.
[5]	DIONIGI G, BACUZZI A, LAVAZZA M, et al.Transoral endoscopic thyroidectomy:preliminary experience in Italy[J].Updates Surg, 2017, 69:225-234.
[6]	WILHELM T, METZIG A.Endoscopic minimally invasive thyroidectomy:first clinical experience[J].Surg Endosc, 2010, 24:1757-1758.
[7]	ANUWONG A, SASANAKIETKUL T, JITPRATOOM P, et al.Transoral endoscopic thyroidectomy vestibular approach (TOETVA):indications, techniques and results[J].Surg Endosc, 2018, 32:456-465.
[8]	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].中华外科学杂志, 2017, 55(8):587-591.
[9]	WITZEL K, MESSENBAECK F, WEITZENDORFER M, et al.Transoral thyroidectomy:limitations, patients'safety, and own experiences[J].Updates Surg, 2017, 69:193-198.
[10]	NAKAJO A, ARIMA H, HIRATA M, et al.TransOral Video.Assisted neck surgery (TOVANS).a new transoral technique of endoscopic thyroidectomy with gasless premandible approach[J].Surg Endosc, 2013, 27:1105-1110.
[11]	PENG X W, LI H, LI Z, et al.Modified transoral endoscopic thyroid surgery for treatment of thyroid cancer:operative steps and video[J].Gland Surg, 2017, 6:742-744.