经双侧腋窝入路行机器人全甲状腺切除术加中央区淋巴结清扫术治疗 109 例甲状腺乳头状癌患者的疗效。

Outcomes of 109 patients with papillary thyroid carcinoma who underwent robotic total thyroidectomy with central node dissection via the bilateral axillo-breast approach.

机构信息

Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

出版信息

Surgery. 2010 Dec;148(6):1207-13. doi: 10.1016/j.surg.2010.09.018.

DOI:10.1016/j.surg.2010.09.018

PMID:21134553

Abstract

BACKGROUND

We developed the bilateral, axillo-breast approach (BABA) to endoscopic thyroidectomy and applied it to the da Vinci robotic surgical system in 2008. Herein, we have analyzed the immediate postoperative outcomes and 1-year follow-up results of robotic BABA total thyroidectomy with central node dissection (CND).

METHODS

In 2008 and 2009, 109 patients with PTC underwent robotic BABA total thyroidectomy with CND. Clinicopathologic characteristics, short- and long-term complications, and postoperative thyroglobulin (Tg) level were obtained prospectively and analyzed.

RESULTS

The mean age was 39 ± 10 years and the male to female ratio was 1:5.8. The mean operation time was 206 ± 36 minutes. Transient recurrent laryngeal nerve (RLN) palsy occurred in 17 cases (16%) and transient hypocalcemia in 21 cases (19%). The median follow-up was 12 months. There were 1 and 2 cases of permanent RLN palsy and permanent hypoparathyroidism, respectively. Postoperative radioactive iodine ablation was performed on 54 patients (50%). Their mean stimulated Tg level was 1.84 ± 6.35 ng/mL and 76% had stimulated Tg levels <1.0 ng/mL.

CONCLUSION

Robotic BABA total thyroidectomy with CND yields good postoperative outcomes. Given the excellent cosmetic outcomes, this technique may be a suitable operative alternative for low-risk patients with PTC.

摘要

背景

我们开发了双侧腋窝入路（Bilateral, axillo-breast approach，BABA）内镜甲状腺切除术，并于 2008 年将其应用于达芬奇机器人手术系统。在此，我们分析了机器人双侧腋窝入路全甲状腺切除术伴中央区淋巴结清扫（Central node dissection，CND）的即刻术后结果和 1 年随访结果。

方法

2008 年至 2009 年，109 例患有 PTC 的患者接受了机器人双侧腋窝入路全甲状腺切除术伴 CND。前瞻性地获得了临床病理特征、短期和长期并发症以及术后甲状腺球蛋白（thyroglobulin，Tg）水平，并进行了分析。

结果

患者的平均年龄为 39 ± 10 岁，男女比例为 1:5.8。平均手术时间为 206 ± 36 分钟。一过性喉返神经（recurrent laryngeal nerve，RLN）麻痹发生 17 例（16%），一过性低钙血症发生 21 例（19%）。中位随访时间为 12 个月。永久性 RLN 麻痹和永久性甲状旁腺功能减退症分别为 1 例和 2 例。54 例（50%）患者术后接受放射性碘消融治疗。他们的平均刺激 Tg 水平为 1.84 ± 6.35ng/ml，76%的患者刺激 Tg 水平<1.0ng/ml。