An exploration of safety and feasibility of transoral vestibular endoscopy in the treatment of thyroid malignant tumors
-
摘要: 目的 探讨经口腔前庭腔镜技术治疗甲状腺恶性肿瘤的安全性与可行性。方法 选取西安市中心医院2019年1月—2021年12月收治的120例甲状腺恶性肿瘤患者，随机分为腔镜手术组(60例)和传统开放手术组(60例)。比较2组患者手术一般情况、术后并发症及术后生存质量。结果 腔镜手术组患者术中失血量、留置引流管时间、平均住院时间显著低于传统开放手术组(P＜0.05)，而手术时间和淋巴结清扫数显著高于传统开放手术组(P＜0.05)。2组患者术后24 h VAS评分、白细胞计数、TgAb(+)、暂时性甲状腺功能减退差异无统计学意义(P＞0.05)，而腔镜手术组C反应蛋白、总引流量、TgAb、血钙高于传统开放手术组，PTH、Tg低于传统开放手术组(P＜0.05)。腔镜手术组患者术后发生声音嘶哑1例、手足麻木2例、皮下积液1例、颏神经损伤2例，并发症总发生率为10.00%，传统开放手术组患者术后发生声音嘶哑5例、手足麻木11例、饮水呛咳1例、术后出血1例、皮下积液4例，并发症总发生率为36.67%，腔镜手术组并发症总发生率低于传统开放手术组(P＜0.05)。腔镜手术组患者生理状况、社会/家庭状况、情感状况、功能状况及生存质量总分均显著低于传统开放手术组(P＜0.05)。结论 经口腔前庭腔镜技术治疗甲状腺恶性肿瘤手术情况和术后恢复较好，术后并发症较少，患者耐受情况良好，安全性值得肯定，具有较高的临床应用价值。Abstract: Objective To investigate the safety and feasibility of transoral vestibular endoscopy in the treatment of patients with thyroid malignant tumors.Methods 120 patients with thyroid cancer admitted to Xi'an Central Hospital from January 2019 to December 2021 were selected and randomly divided into endoscopic surgery group(60 cases) and traditional open surgery group(60 cases). The general operation conditions, postoperative complications and postoperative quality of life were compared between the two groups.Results The intraoperative blood loss, indwelling drainage tube time and average length of hospital stay in the endoscopic surgery group were significantly lower than those in the traditional open surgery group (P < 0.05), while the operation time and number of lymph nodes dissected were significantly higher than those in the traditional open surgery group (P < 0.05). There was no significant differences in VAS score at 24h after surgery, white blood cell count, TgAb (+) and temporary hypothyroidism between the two groups at 24 h after operation (P >0.05). The CRP, total drainage volume, TgAb and serum calcium in the endoscopic surgery group were higher than those in the traditional open surgery group, and the PTH and Tg were lower than those in the traditional open surgery group (P < 0.05).One case of hoarseness, 2 cases of extremities numbness, 1 case of subcutaneous effusion and 2 cases of chin nerve injury occurred in the endoscopic surgery group, the total incidence of postoperative complications was 10.00%. Five cases of hoarseness, 11 cases of choking cough limbs numbness, 1 case of drinking water, 1 case of postoperative bleeding and 4 cases of subcutaneous effusion occurred in the traditional open surgery group, the total postoperative incidence of complications was 36.67%, the total incidence of complications in endoscopic surgery group was lower than that in traditional open surgery group (P < 0.05). The total scores of physiological status, social/family status, emotional status, functional status and quality of life in endoscopic surgery group were significantly lower than those in traditional open surgery group (P < 0.05).Conclusion The application of oral vestibular endoscopy in the treatment of thyroid malignant tumors has the advantages of good surgical status and postoperative recovery, fewer postoperative complications.The patient was well tolerated, with positive safety, this technique has high clinical application value.
-
-
表 1 2组患者一般资料比较
组别 例数 性别 年龄/岁 肿瘤大小/cm 单侧腺叶切除 双侧腺叶切除 女性 男性 腔镜手术组 60 37(61.67) 23(38.33) 46.37±5.29 1.28±0.43 37(61.67) 23(38.33) 传统开放手术组 60 35(58.33) 25(41.67) 45.28±5.31 1.31±0.52 40(66.67) 20(33.33) t值 0.139 1.126 0.344 0.326 P值 0.709 0.262 0.731 0.568 
下载: 导出CSV
表 2 2组患者手术一般情况比较
组别 例数 手术时间/min 术中失血量/mL 留置引流管时间/min 淋巴结清扫数/枚 平均住院时间/d 腔镜手术组 60 113.56±12.41 15.37±3.24 34.56±6.32 9.26±1.35 4.12±1.24 传统开放手术组 60 98.36±9.42 26.52±5.43 48.72±8.43 7.48±1.22 4.47±1.35 t值 7.557 13.659 10.410 7.577 2.114 P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001 0.037
下载: 导出CSV
表 3 2组患者术后相关指标比较
组别 例数 术后24h VAS评分/分 白细胞计数/(×109·L-1) CRP/(mg·L-1) 总引流量/mL 血钙/(mmol·L-1) 腔镜手术组 60 1.82±0.46 10.02±2.53 16.54±4.371) 193.56±52.471) 1.84±0.371) 传统开放手术组 60 1.76±0.53 10.43±3.22 9.68±2.31 128.49±36.52 1.62±0.35 组别 例数 Tg/(μg·L-1) TgAb/(IU·mL-1) TgAb(+)/[n(%)] 暂时性甲状腺功能减退/[n(%)] PTH/(pg·mL-1) 腔镜手术组 60 0.24±0.061) 2.51±0.621) 12(20.00) 10(16.67) 25.38±4.291) 传统开放手术组 60 0.35±0.08 1.94±0.58 8(13.33) 5(8.33) 27.46±5.32 与传统开放手术组比较，1)P＜0.05。
下载: 导出CSV
表 4 2组患者术后并发症发生情况比较
例(%) 组别 例数 声音嘶哑 手足麻木 饮水呛咳 术后出血 皮下积液 颏神经损伤 腔镜手术组 60 1(1.67) 2(3.33) 0 (0) 0 (0) 1(1.67) 2(3.33) 传统开放手术组 60 5(8.33) 11(18.33) 1(1.67) 1(1.67) 4(6.67) 0 (0) t值 2.807 6.988 1.008 1.008 1.878 2.034 P值 0.094 0.008 0.315 0.315 0.171 0.154
下载: 导出CSV
表 5 2组患者术后生存质量比较
组别 例数 生理状况 社会/家庭状况 情感状况 功能状况 生存质量总分 腔镜手术组 60 13.42±3.25 14.55±3.28 11.37±3.14 12.62±3.23 50.48±4.37 传统开放手术组 60 18.36±4.27 20.49±4.36 16.58±3.22 17.82±3.46 71.36±5.29 t值 7.131 8.433 8.973 8.510 23.571 P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001
下载: 导出CSV
-
[1] 陈懿, 张姝, 张刚, 等. 50例经口腔前庭入路腔镜甲状腺手术临床应用体会[J]. 肿瘤预防与治疗, 2019, 32(5): 441-446. doi: 10.3969/j.issn.1674-0904.2019.05.010
[2] Guo F, Wang W, Zhu X, et al. Comparative Study Between Endoscopic Thyroid Surgery via the Oral Vestibular Approach and the Areola Approach[J]. J Laparoendosc Adv Surg Tech A, 2020, 30(2): 170-174. doi: 10.1089/lap.2019.0562
[3] Zheng G, Ma C, Sun H, et al. Safety and surgical outcomes of transoral endoscopic thyroidectomy vestibular approach for papillary thyroid cancer: A two-centre study[J]. Eur J Surg Oncol, 2021, 47(6): 1346-1351. doi: 10.1016/j.ejso.2021.01.028
[4] 武振, 房居高, 陈笑, 等. 经口腔前庭入路腔镜甲状腺手术中神经功能的保护[J]. 中华耳鼻咽喉头颈外科杂志, 2020, 55(10): 893-898. doi: 10.3760/cma.j.cn115330-20200526-00447
[5] Wang T, Wu Y, Xie Q, et al. Safety of central compartment neck dissection for transoral endoscopic thyroid surgery in papillary thyroid carcinoma[J]. Jpn J Clin Oncol, 2020, 50(4): 387-391. doi: 10.1093/jjco/hyz195
[6] Luna-Ortiz K, Gómez-Pedraza A, Anuwong A. Lessons Learned from the Transoral Endoscopic Thyroidectomy with Vestibular Approach(TOETVA)for the Treatment of Thyroid Carcinoma[J]. Ann Surg Oncol, 2020, 27(5): 1356-1360. doi: 10.1245/s10434-019-07899-3
[7] Kim SY, Kim SM, Makay Ö, et al. Transoral endoscopic thyroidectomy using the vestibular approach with an endoscopic retractor in thyroid cancer: experience with the first 132 patients[J]. Surg Endosc, 2020, 34(12): 5414-5420. doi: 10.1007/s00464-019-07336-2
[8] 余富杰, 赵大威, 徐琰. 经口腔前庭腔镜甲状腺切除手术与传统开放性手术的比较[J]. 中国内镜杂志, 2020, 26(4): 60-66. doi: 10.3969/j.issn.1007-1989.2020.04.012
[9] Shen S, Hu X, Qu R, et al. Comparing quality of life between patients undergoing trans-areola endoscopic thyroid surgery and trans-oral endoscopic thyroid surgery[J]. BMC Surg, 2021, 21(1): 277. doi: 10.1186/s12893-021-01267-3
[10] Johri G, Chand G, Mishra A, et al. Endoscopic versus Conventional Thyroid Surgery: A Comparison of Quality of Life, Cosmetic Outcomes and Overall Patient Satisfaction with Treatment[J]. World J Surg, 2020, 44(12): 4118-4126. doi: 10.1007/s00268-020-05732-7
[11] 彭亚, 柳岸, 彭小伟. 经口腔前庭内镜甲状腺癌切除术治疗甲状腺癌的临床疗效[J]. 癌症进展, 2019, 17(13): 1531-1533. https://www.cnki.com.cn/Article/CJFDTOTAL-AZJZ201913014.htm
[12] Wongwattana P, Laoveerakul P, Santeerapharp A. A comparison of efficacy and quality of life between transoral endoscopic thyroidectomy vestibular approach(TOETVA)and endoscopic thyroidectomy axillo-breast approach(ETABA)in thyroid surgery: non-randomized clinical trial[J]. Eur Arch Otorhinolaryngol, 2021, 278(10): 4043-4049. doi: 10.1007/s00405-021-06639-2
[13] Wang Y, Zhou S, Liu X, et al. Transoral endoscopic thyroidectomy vestibular approach vs conventional open thyroidectomy: Meta-analysis[J]. Head Neck, 2021, 43(1): 345-353. doi: 10.1002/hed.26486
[14] 周建平, 徐飞, 梁文丰, 等. 腔镜下经口腔前庭与全乳晕入路甲状腺手术的倾向得分匹配分析[J]. 中国内镜杂志, 2021, 27(5): 34-39. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGNJ202105006.htm
[15] Sun H, Zheng H, Wang X, et al. Comparison of transoral endoscopic thyroidectomy vestibular approach, total endoscopic thyroidectomy via areola approach, and conventional open thyroidectomy: a retrospective analysis of safety, trauma, and feasibility of central neck dissection in the treatment of papillary thyroid carcinoma[J]. Surg Endosc, 2020, 34(1): 268-274. doi: 10.1007/s00464-019-06762-6
[16] Khafif A, Cohen O, Masalha M, et al. Adoption of the transoral endoscopic vestibular approach by head and neck surgeons without prior laparoscopic/robotic experience[J]. Head Neck, 2021, 43(2): 496-504. doi: 10.1002/hed.26503
[17] Kadem SG, Habash SM, Jasim AH. Transoral Endoscopic Thyroidectomy via Vestibular Approach: A series of the first ten cases in Iraq[J]. Sultan Qaboos Univ Med J, 2019, 19(1): e68-e72. doi: 10.18295/squmj.2019.19.01.013
[18] 彭翠娥, 王萪达, 李赞, 等. 经口腔前庭腔镜甲状腺手术后患者生命质量的调查研究[J]. 中国实用护理杂志, 2019, 35(32): 2503-2508. doi: 10.3760/cma.j.issn.1672-7088.2019.32.005
[19] Rege SA, Janesh M, Surpam S, et al. Transoral endoscopic thyroidectomy using vestibular approach: A single center experience[J]. J Postgrad Med, 2019, 65(2): 81-86.
[20] Qu S, Zhang W, Li S, et al. The Vacuum-Assisted Breast Biopsy System is an Effective Strategy for the Treatment of Gynecomastia[J]. Aesthetic Plast Surg, 2021, 45(2): 404-410. doi: 10.1007/s00266-020-01931-8
[21] Yi W, Kim BH, Kim M, et al. Short-term bone marrow suppression in differentiated thyroid cancer patients after radioactive iodine treatment[J]. Endocr J, 2020, 67(12): 1193-1198. doi: 10.1507/endocrj.EJ20-0242
[22] Choi HG, Park B, Ji YB, et al. Depressive Disorder in Thyroid Cancer Patients after Thyroidectomy: A Longitudinal Follow-up Study Using a National Cohort[J]. Otolaryngol Head Neck Surg, 2019, 160(2): 239-245. doi: 10.1177/0194599818802190
-