Application of da Vinci robot's bilateral axillo-breast approach in thyroid surgery of obese patients
-
摘要: 目的：探讨肥胖对机器人甲状腺手术操作及手术结果的影响。方法：回顾性分析2014-02-2017-11期间济南军区总医院收治且通过双侧腋窝乳晕入路（BABA）行机器人甲状腺手术446例患者的临床资料，根据体重指数（BMI）将患者分为BMI<25 kg/m2组、BMI 25~30 kg/m2和BMI>30 kg/m2组，比较3组良恶性患者的手术时间、术后引流液体量、术后住院时间、癌灶大小（恶性）、淋巴结转移例数（恶性）、美容效果满意度，喉返神经损伤及甲状旁腺功能减退等相关手术并发症情况。统计学方法用方差分析及χ2检验对比3组之间各项指标的差异，以P<0.05为差异有统计学意义。结果：3组患者的手术时间、术后平均住院时间、术后引流液体量的差异无统计学意义（P>0.05）。①术中及术后病理结果均为良性：BMI<25 kg/m2组69例，BMI 25~30 kg/m2组48例，BMI>30 kg/m2组8例，暂时性喉返神经损伤分别为1例、0例、0例；暂时性甲状旁腺功能减退分别为3例、2例、1例。②术中及术后病理结果均为恶性：BMI<25 kg/m2组180例，BMI 25~30 kg/m2组119例，BMI>30 kg/m2组22例，暂时性喉返神经损伤分别为2例、1例、0例；暂时性甲状旁腺功能减退分别为64例、29例、5例。③3组恶性患者中：BMI<25 kg/m2组1例患者术后出现淋巴漏；BMI 25~30 kg/m2组1例患者出现皮下隧道出血，1例患者术中出现淋巴漏。结论：超重或肥胖患者行达芬奇机器人甲状腺手术操作安全可靠，没有增加手术并发症的风险，同时具有良好的美容效果。Abstract: Objective: To discuss the effect of obesity on the operation of thyroid gland surgery and surgical results.Method: The clinical data of 446 patients who underwent robot thyroid surgery through bilateral axillo-breast approach (BABA) from the General Hospital of Jinan Military region from February 2014 to November 2017 were analyzed retrospectively, and the patients were divided into BMI<25 kg/m2 group, BMI 25-30 kg/m2 group and BMI>30 kg/m2 group according to body mass index (BMI). The operative complications were compared between the three groups of benign and malignant patients, such as operation time, postoperative lead flow, postoperative hospitalization time, tumor size (malignant), lymph node metastasis (malignant), cosmetic satisfaction score, laryngeal nerve injury and parathyroid function decrease. Statistical methods using Variance analysis and χ2 test to compare the differences between the two groups of indicators, difference is statistically significant (P<0.05).Result: The difference of operation time, postoperative average hospitalization time and postoperative drainage fluid volume in 3 groups was not statistically significant(P>0.05). ①Intraoperative and postoperative pathological results were benign:BMI<25 kg/m2 group 69 cases, BMI 25-30 kg/m2 group 48 cases, BMI>30 kg/m2 group 8 cases, temporary recurrent laryngeal nerve injury were 1 case, 0 case and 0 case respectively, temporary parathyroid function decrease 3 cases, 2 cases and 1 case. ②Intraoperative and postoperative pathological results were malignant:BMI<25 kg/m2 group 180 cases, BMI 25-30 kg/m2 group 119 cases,BMI>30 kg/m2 group 22 cases, temporary recurrent laryngeal nerve injury were 2 cases,1 case and 0 case respectively, temporary parathyroid dysfunction in 64 cases,29 cases and 5 cases respectively.③1 patient in BMI<25 kg/m2 group had lymphatic leakage after operation, 1 patient in BMI 25-30 kg/m2 group had subcutaneous tunnel hemorrhage, and 1 patient had lymphatic leakage during operation.Conclusion: For overweight or obese patients, the da Vinci robot thyroid operation is reliable, does not increase the risk of surgical complications, but also has a good cosmetic effect.
-
Key words:
- da Vinci robot /
- body mass index /
- thyroid surgery /
- bilateral axillo-breast approach
-
-
[1] OBERMAN B, KHAKU A, CAMACHO F, et al.Relationship between obesity, diabetes and the risk of thyroid cancer[J].Am J Otolaryngol, 2015, 36:535-541.
[2] MILONE M, MUSELLA M, CONZO G, et al.Thyroidectomy in high body mass index patients:A single center experience[J].Int J Surg, 2016, 28:38-41.
[3] 中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会.机器人手术系统辅助甲状腺和甲状旁腺手术专家共识[J].中国实用外科杂志, 2016, 36(11):1165-1170.
[4] GARVEY W T, MECHANICK J I, BRETT E M, et al.American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity[J].Endocr Pract, 2016, 22:1291-1300.
[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, 朱见, 范子义, 等.达芬奇机器人行甲状腺癌颈侧区清扫的临床研究[J].中华腔镜外科杂志(电子版), 2016, 9(4):212-216.
[7] HAUGEN B R, ALEXANDER E K, BIBLE K C, et al.2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer:The American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer[J].Thyroid, 2016, 26:1-133.
[8] BERNARD W S, CHRISTOPHER P W.World cancer report 2014[M].Lyon:International Agency for Research on Cancer, 2015:1-953.
[9] SIEGEL R L, MILLER K D, JEMAL A.Cancer statistics, 2017[J].CA Cancer J Clin, 2017, 67:7-30.
[10] WANG Y C, LIU K, XIONG J J, et al.Robotic thyroidectomy versus conventional open thyroidectomy for differentiated thyroid cancer:meta-analysis[J].JLaryngol Otol, 2015, 129:558-567.
[11] NCD Risk Factor Collaboration (NCD-RisC).Trends in adult body-mass index in 200countries from 1975to 2014:apooled analysis of 1698population-based measurement studies with 19.2 million participants[J].Lancet, 2016, 387:1377-1396.
[12] HWANG Y, LEE K E, PARK Y J, et al.Annual average changes in adult obesity as a risk factor for papillary thyroid cancer:a large-scale case-control study[J].Medicine (Baltimore), 2016, 95:e2893.
[13] DIERINGER P, KLASS E M, CAINE B, et al.Associations between body mass and papillary thyroid cancer stage and tumor size:apopulation-based study[J].J Cancer Res Clin Oncol, 2015, 141:93-98.
[14] KIM S H, PARK H S, KIM K H, et al.Correlation between obesity and clinicopathological factors in patients with papillary thyroid cancer[J].Surg Today, 2015, 45:723-729.
[15] 贺青卿, 董学峰, 于芳, 等.甲状腺乳头状癌淋巴转移的特点及临床处理策略[J].中华内分泌外科杂志, 2015, 9(1):1-3.
[16] 中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会.经胸前入路腔镜甲状腺手术专家共识(2017版)[J].中国实用外科杂志, 2017, 37(12):1369-1373.
[17] KANG S W, JEONG J J, YUN J S, et al.Robot-assisted endoscopic surgery for thyroid cancer:experience with the first 100 patients[J].Surg Endosc, 2009, 23:2399-2406.
[18] 贺青卿.规范达芬奇机器人外科手术系统在甲状腺手术中的应用[J].中华外科杂志, 2017, 55(8):570-573.
[19] 朱见, 贺青卿, 庄大勇, 等.双腋窝乳晕径路达芬奇机器人甲状腺癌手术并发症防治[J].国际外科学杂志, 2017, 44(2):129-132.
[20] 贺青卿, 李小磊, 庄大勇.机器人甲状腺手术的发展现状和思考[J].中华内分泌外科杂志, 2017, 11(5):356-358.
[21] 王猛, 郑鲁明, 于芳, 等.达芬奇机器人手术治疗甲状腺微小癌150例临床分析[J].中国实用外科杂志, 2016, 36(5):540-546.
-
计量
- 文章访问数: 69
- PDF下载数: 54
- 施引文献: 0
下载: