Clinical study of bilateral axillo-breast approach robot in obese women with thyroid cancer
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摘要: 目的 探讨双侧乳晕腋窝径路(bilateral axillo-breast approach，BABA)机器人在肥胖女性甲状腺癌手术应用中的安全性及可行性。方法 回顾性分析2018年5月—2021年12月在解放军第九六〇医院甲状腺乳腺外科行达芬奇机器人甲状腺癌手术的81例肥胖女性患者(机器人组)的临床资料，与同期行开放手术的106例肥胖女性甲状腺癌患者(开放组)的临床资料进行比较。统计所有患者的年龄、体重指数(BMI)、手术平均时间、术后平均引流量、肿瘤直径、中央区及颈侧区淋巴结清扫数目、术后肿瘤分期、中央区及颈侧区阳性淋巴结数目、术后美容效果满意评分、术后平均住院时间及术后并发症的情况。采用SPSS 26.0统计软件对结果进行分析，计数资料采用χ2检验进行比较，计量资料采用t检验进行比较。结果 所有患者顺利完成手术，机器人组手术无中转开放，术后病理结果均为甲状腺乳头状癌。机器人组手术时间(144.62±36.38) min，长于开放组[(117.06±18.72) min](P < 0.05)。机器人组的平均年龄(40.25±9.27)岁，低于开放组[(49.59±8.70)岁](P < 0.05)。机器人组术后美容效果满意评分(9.44±0.65)分，高于开放组[(5.23±1.07)分](P < 0.05)。两组患者的肿瘤直径、BMI、术后平均引流量、暂时性的甲状旁腺功能减退及喉返神经损伤、中央区及颈侧区淋巴结清扫数目、术后平均住院时间、中央区及颈侧区阳性淋巴结数目等差异均无统计学意义(P>0.05)。两组患者术后均未发生永久性的甲状旁腺功能减退及喉返神经损伤。结论 BABA径路机器人在肥胖女性甲状腺癌手术中应用安全可行，术后美容效果更好。Abstract: Objective To explore the safety and feasibility of bilateral axillo-breast approach (BABA) robot in the operation of thyroid cancer in obese women.Methods The clinical data of 81 obese female patients who underwent da Vinci robotic thyroid cancer surgery(robotic group) at the Department of Thyroid and Breast Surgery, PLA 960 Hospital from May 2018 to December 2021 were retrospectively analyzed and compared with the clinical data of 106 obese female thyroid cancer patients who underwent open surgery(open group) during the same period. The age, body mass index(BMI), mean time of surgery, mean postoperative drainage, tumor diameter, postoperative tumor stage, number of lymph node dissection in the central and lateral cervical regions, number of positive lymph nodes in the central and lateral cervical regions, postoperative cosmetic outcome satisfaction score, mean postoperative hospital stay and postoperative complications of all patients were counted. The results were analyzed using SPSS 26.0 statistical software, and the count data were compared using the χ2 test, and the measurement data were compared using the t test.Results All patients completed the operation successfully, and there was no conversion in the robot group, postoperative pathological results were all composed of papillary thyroid carcinoma. The operation time in the robot group was(144.62±36.38) min, which was longer than that in the open group(117.06±18.72) min(P < 0.05). The average age of the robot group was(40.25±9.27) years, which was lower than that of the open group(49.59±8.70) years(P < 0.05). The satisfactory score of cosmetic effect in the robot group(9.44±0.65) was higher than that in the open group(5.23±1.07)(P < 0.05). There was no significant difference in tumor diameter, BMI, average postoperative drainage, temporary hypoparathyroidism and recurrent laryngeal nerve injury, number of central and lateral cervical lymph node dissection, number of positive lymph nodes in the central and lateral cervical regions, and average postoperative hospital stay between the two groups. There was no permanent hypoparathyroidism and recurrent laryngeal nerve injury in both groups.Conclusion The application of BABA pathway robot in thyroid cancer surgery in obese women is safe and feasible, and the cosmetic effect is better after operation.
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Key words:
- thyroidectomy /
- Da Vinci robot /
- thyroid neoplasms /
- obesity /
- female sex
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表 1 机器人组与开放组患者基线资料
X±S 组别 例数 年龄/岁 BMI/(kg/m2) 肿瘤直径/mm 机器人组 81 40.25±9.27 30.51±2.69 7.04±4.01 开放组 106 49.59±8.70 30.37±2.16 8.33±5.52 t值 7.076 0.502 1.773 P值 < 0.001 0.382 0.078 
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表 2 机器人组与开放组患者手术结果的比较
组别 例数 手术平均时间/min 术后平均引流量/mL 术后平均住院时间/d 术后肿瘤分期/例 Ⅰ期 Ⅱ期 机器人组 81 144.62±36.38 224.35±71.00 6.68±1.92 79 2 开放组 106 117.06±18.72 219.12±65.57 6.77±1.41 94 12 t/χ2值 6.72 0.52 0.39 5.19 P值 < 0.05 0.60 0.70 0.02
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表 3 机器人组与开放组患者淋巴结清扫数目及阳性数目的比较
枚，X±S 组别 例数 中央区淋巴结清扫数目 中央区阳性淋巴结数目 颈侧区淋巴结清扫数目 颈侧区阳性淋巴结数目 机器人组 81 11.96±6.41 1.36±3.45 12.42±9.66 0.65±1.93 开放组 106 11.54±5.71 1.83±3.11 13.72±9.73 1.14±2.79 t值 0.48 0.98 0.91 1.35 P值 0.63 0.33 0.37 0.18
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表 4 机器人组与开放组术后并发症及美容效果评分比较
组别 例数 甲状旁腺功能减退/例(%) 喉返神经损伤/例(%) 术后美容效果满意评分/分 暂时性 永久性 暂时性 永久性 机器人组 81 22(27.1) 0 5(6.2) 0 9.44±0.65 开放组 106 36(34.0) 0 9(8.5) 0 5.23±1.07 t/χ2值 0.99 - 0.36 - 31.27 P值 0.32 1.00 0.55 1.00 < 0.01
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