经腋下入路机器人辅助甲状腺手术的初步经验

梁发雅; 韩萍; 蔡谦; 陈仁辉; 余诗桐; 罗明睿; 黄晓明

doi:10.13201/j.issn.1001-1781.2018.14.003

经腋下入路机器人辅助甲状腺手术的初步经验

- 中山大学孙逸仙纪念医院耳鼻咽喉科(广州, 510120)
基金项目:
中山大学临床研究5010计划项目（No：201008）

详细信息

通讯作者: 黄晓明,E-mail:xiaoming.huang@126.com

中图分类号: R736.1

收稿日期: 2018-06-17

Robot-assisted transaxillary thyroidectomy: our early experience

- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China

More Information

Corresponding author: HUANG Xiaoming, E-mail: xiaoming.huang@126.com

Received Date: 17 June 2018

摘要

摘要: 目的：评价经腋下入路机器人辅助甲状腺手术的可行性、有效性及安全性。方法：前瞻性收集2016-11-2018-05期间经腋下入路机器人辅助甲状腺手术66例患者的临床资料并进行分析。66例患者平均年龄（38.61±11.72）岁，女57例，男9例。术前细针穿刺病理诊断为甲状腺乳头状癌58例，甲状腺滤泡性肿瘤8例。结果：全部患者均顺利完成无注气腋下入路机器人甲状腺手术，无中转开放手术，其中单侧腋下入路腺叶及峡部切除+同侧中央区清扫54例，单侧腺叶切除+对侧腺叶近全切除8例，腋下入路联合同侧耳后入路进行双侧腺叶切除+同侧中央区及Ⅱ~Ⅳ区清扫4例，平均手术时间（124.30±23.41） min，平均出血量（17.73±8.28） ml。甲状腺乳头状癌肿瘤平均直径（0.71±6.22） cm，术后引流量为（67.57±25.11） ml，平均术后住院日为（3.24±0.81） d。3例患者（4.5%）术后出现暂时性喉返神经麻痹，1例（1.5%）术后出现暂时性低钙，均于术后1个月恢复。无术后出血、皮下气肿、饮水呛咳以及永久性低血钙的表现。甲状腺乳头状癌患者平均Ⅵ区淋巴结清扫数目（6.26±4.76）个，其中21例（36.2%）淋巴结转移，术后分期T₁ 54例，T₂ 4例；N_1a 17例，N_1b 4例。随访时间1~18个月，术后1个月美观VAS评分为（9.66±0.54）分，B超提示患侧甲状腺无残留腺体，局部及区域无复发。结论：经腋下入路机器人辅助甲状腺手术安全可行，术后美观效果好，可作为甲状腺疾病治疗的一种选择。
- 甲状腺肿瘤 /
- 机器人辅助甲状腺手术 /
- 微创外科
Abstract: Objective: To evaluate the feasibility, effectiveness and safety of robot-assisted transaxillary thyroidectomy (RATT).Method: The clinical data of 66 patients undergoing RATT from November 2016 to May 2018 were prospectively collected and analyzed. The average age was (38.61±11.72) years, 57 cases were female and 9 cases were male. Preoperative fine needle aspiration biopsy revealed papillary thyroid carcinoma in 58 cases and follicular thyroid tumor in 8 cases.Result: All the patients successfully completed RATT, and there was no open operation, in which 54 cases of ipsilateral lobetomy and isthmus resection and ipsilateral central lymph node dissection, 8 cases with ipsilateral lobectomy and contralateral near-total lobectomy, and total thyroidectomy with ipsilateral central lymph node dissection and selective neck dissection combined with retroauricular approach in 4 cases. The mean operative time was (124.30±23.41) min, and the average bleeding volume was (17.73±8.28) ml. The mean diameter of thyroid papillary carcinoma was (0.71±6.22) cm, and the postoperative drainage volume was (67.57±25.11) ml. The average postoperative hospitalization time was (3.24±0.81) days. 3 cases (4.5%) had temporary laryngeal nerve palsy after operation, and 1 case (1.5%) had temporary hypocalcemia after operation, all recovered after one month. No postoperative bleeding, subcutaneous emphysema, drinking water cough and permanent hypocalcemia were observed. The average numbers of lymph node dissection in PTC patients were (6.26±4.76), of which 21 cases (36.2%) had lymph node metastasis, postoperative stage T₁ 54 cases, T₂ 4 cases, N_1a 17 cases, N_1b 4 cases. The follow-up time were 1-18 months. The postoperative cosmetic VAS score in January was (9.66±0.54). Ultrasound showed no residual glands in the affected thyroid gland, and there was no recurrence in the local and regional regions.Conclusion: RATT is safe and feasible with good aesthetic effect and can be used as an option for the treatment of thyroid diseases.
- thyroid neoplasms /
- robot-assisted transaxillary thyroidectomy /
- minimally invasive surgery

HTML全文

参考文献(15)

[1]	KANG S W, JEONG J J, YUN J S, et al.Robot-assisted endoscopic surgery for thyroid cancer:experience with the first 100patients[J].Surg Endosc, 2009, 23:2399-2406.
[2]	KANG S W, JEONG J J, NAM K H, et al.Robot-assisted endoscopic thyroidectomy for thyroid malignancies using agasless transaxillary approach[J].J Am Coll Surg, 2009, 209:e1-e7.
[3]	KIM W S, KOH Y W, BYEON H K, et al.Robot-assisted neck dissection via a transaxillary and retroauricular approach versus a conventional transcervical approach in papillary thyroid cancer with cervical lymph node metastases[J].J Laparoendosc Adv Surg Tech A, 2014, 24:367-372.
[4]	GOEPFERT R P, LIU C, RYAN W R.Trans-oral robotic surgery and surgeon-performed trans-oral ultrasound for intraoperative location and excision of an isolated retropharyngeal lymph node metastasis of papillary thyroid carcinoma[J].Am J Otolaryngol, 2015, 36:710-714.
[5]	贺青卿, 朱见, 范子义, 等.达芬奇机器人腋乳径路与传统开放手术治疗甲状腺微小癌的对照研究[J].中华外科杂志, 2016, 54(1):51-55.
[6]	贺青卿, 周鹏, 庄大勇, 等.经腋窝与胸前径路da Vinci Si机器人甲状腺腺叶切除二例[J].国际外科学杂志, 2014, 41(2):104-107.
[7]	梁发雅, 蔡谦, 韩萍, 等.经腋下径路无注气内镜下甲状腺微小乳头状癌手术与传统手术的对照研究[J].肿瘤预防与治疗, 2017, 30(2):92-95, 101.
[8]	HUANG X M, SUN W, ZENG L, et al.Gasless endoscopic thyroidectomy via an anterior chest approach-a review of 219cases with benign tumor[J].World J Surg, 2011, 35:1281-1286.
[9]	黄晓明, 孙伟, 洪云, 等.胸前入路无注气内镜手术治疗早期甲状腺乳头状癌的初步研究[J].中华耳鼻咽喉头颈外科杂志, 2012, 47(7):571-574.
[10]	KIM W S, KOH Y W, BYEON H K, et al.Robot-assisted neck dissection via a transaxillary and retroauricular approach versus a conventional transcervical approach in papillary thyroid cancer with cervical lymph node metastases[J].J Laparoendosc Adv Surg Tech A, 2014, 24:367-372.
[11]	KIM S K, WOO J W, PARK I, et al.Propensity scorematched analysis of robotic versus endoscopic bilateral axillo-breast approach (BABA) thyroidectomy in papillary thyroid carcinoma[J].Langenbecks Arch Surg, 2017, 402:243-250.
[12]	KIM M J, CHUNG W Y.Yonsei experience of 5000gasless transaxillary robotic thyroidectomies:reply[J].World J Surg, 2018, 42:2281-2282.
[13]	DRALLE H.Robot-assisted transaxillary thyroid surgery:as safe as conventional-access thyroid surgery[J]?Eur Thyroid J, 2013, 2:71-75.
[14]	LANG B H, WONG C K, TSANG J S, et al.A systematic review and meta-analysis comparing outcomes between robotic-assisted thyroidectomy and non-robotic endoscopic thyroidectomy[J].J Surg Res, 2014, 191:389-398.
[15]	LEE S, RYU H R, PARK J H, et al.Early surgical outcomes comparison between robotic and conventional open thyroid surgery for papillary thyroid microcarcinoma[J].Surgery, 2012, 151:724-730.