Department of Thyroid Surgery, Yantai Yuhuangding Hospital, Yantai, 264000, Shangdong, China.
Department of Thyroid Surgery, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China.
Surg Endosc. 2020 Jan;34(1):268-274. doi: 10.1007/s00464-019-06762-6. Epub 2019 Jul 25.
Transoral endoscopic thyroidectomy vestibular approach (TOETVA) and total endoscopic thyroidectomy via areola approach (ETA) are commonly used endoscopic thyroidectomy approaches. This study compares the effectiveness of these approaches with conventional open thyroidectomy (COT) in terms of safety, associated trauma, and feasibility of central neck dissection in the treatment of papillary thyroid carcinoma (PTC).
This retrospective study included patients who underwent TOETVA (n = 100), ETA (n = 119), and COT (n = 289). All patients had a pathological diagnosis of PTC and underwent unilateral lobectomy and central neck dissection. We analyzed operative time, postoperative drainage volume, postoperative C-reactive protein (CRP), preoperative and postoperative white blood cell (WBC) count and parathyroid hormone (PTH) levels, parathyroid damage, hoarseness, total number of central lymph nodes, and number of metastatic central lymph nodes.
The clinical characteristics across the three groups were similar except for patient sex and age. There was a higher proportion of young women in the TOETVA and ETA groups than in the COT group. There were significant differences between the three groups regarding operative time (P = 0.000), postoperative drainage volume (P = 0.000), postoperative CRP (P = 0.000), ∆WBC (P = 0.000), and length of postoperative hospital stay (P = 0.021); in the TOETVA and ETA groups, operative time (P = 0.445), postoperative drainage volume (P = 0.677), and length of postoperative hospital stay (P = 0.145) were not significantly different. The percentage of cases with parathyroid gland damage (P = 0.459) and hoarseness (P > 0.05) was similar in all groups. All three procedures were efficient in performing a central lymph node dissection.
Although considered more traumatic, TOETVA and ETA are both safe treatment options for PTC. They can both achieve similar therapeutic effects of central neck dissection in the treatment of PTC when compared with open surgery.
经口内镜甲状腺手术（TOETVA）和乳晕入路全内镜甲状腺手术（ETA）是常用的内镜甲状腺手术方法。本研究比较了这些方法与传统开放甲状腺切除术（COT）在治疗甲状腺乳头状癌（PTC）时的安全性、相关创伤和中央颈部清扫术的可行性。
本回顾性研究纳入了接受 TOETVA（n=100）、ETA（n=119）和 COT（n=289）的患者。所有患者均经病理诊断为 PTC，并接受单侧叶切除术和中央颈部清扫术。我们分析了手术时间、术后引流量、术后 C 反应蛋白（CRP）、术前和术后白细胞（WBC）计数和甲状旁腺激素（PTH）水平、甲状旁腺损伤、声音嘶哑、中央淋巴结总数和中央淋巴结转移数。
三组患者的临床特征除了患者性别和年龄外均相似。TOETVA 和 ETA 组年轻女性比例高于 COT 组。三组患者在手术时间（P=0.000）、术后引流量（P=0.000）、术后 CRP（P=0.000）、ΔWBC（P=0.000）和术后住院时间（P=0.021）方面存在显著差异；在 TOETVA 和 ETA 组，手术时间（P=0.445）、术后引流量（P=0.677）和术后住院时间（P=0.145）无显著差异。三组甲状旁腺损伤（P=0.459）和声音嘶哑（P>0.05）的发生率相似。所有三种手术方法在进行中央淋巴结清扫术时都很有效。
尽管被认为创伤更大，但 TOETVA 和 ETA 都是治疗 PTC 的安全选择。与开放手术相比，它们在治疗 PTC 时均可达到相似的中央颈部清扫术疗效。
