Li H, Peng X W, Li Z, Peng W, Zhou X, Song D J, Zhou B, Lyu C L, Wu P, Ou Y, Mao H X, Liu Z Y
Department of Head and Neck Surgry, Hunan Province Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, China.
Zhonghua Wai Ke Za Zhi. 2019 Sep 1;57(9):686-690. doi: 10.3760/cma.j.issn.0529-5815.2019.09.008.
To investigate the safety and feasibility of the modified transoral endoscopic thyroidectomy vestibular approach (TOETVA) by dissection of mental nerve in clinical practice. Totally 140 patients underwent the modified TOETVA from the Department of Head and Neck Surgery, Hunan Cancer Hospital from July 2016 to June 2018 were analyzed retrospectively. There were 130 females and 10 males, aging (35.4±9.8) years (range: 11 to 56 years). The operative time, intraoperative blood loss, postoperative hospital stay, postoperative suction drainage, postoperative pain score, postoperative cosmetic satisfaction and postoperative complications (recurrent laryngeal nerve palsy, hypoparathyroidism, infection, pneumoderm, seroma and mental nerve injury) were summarized. Of the 140 patients, 1 patient was transferred to open surgery. Fifty-nine patients underwent thyroidectomy with an operation time of (100.8±18.9) minutes. Sixty-three patients underwent thyroidectomy and central lymphadenectomy with an operation time of (112.1±16.6) minutes. Eighteen cases underwent total thyroidectomy and central lymphadenectomy with an operation time of (185.3±25.9) minutes. The postoperative hospital stay was (3.76±0.98) days. The postoperative drainage was (96.8±36.2) ml. The 24-hour postoperative pain score was 2.66±1.23, the postoperative cosmetic satisfaction was 9.65±0.24. Among the postoperative complications, there were 3 cases of temporary recurrent laryngeal nerve palsy, 2 cases of permanent recurrent laryngeal nerve palsy, 4 cases of temporary hypoparathyroidism but no permanent hypoparathyroidism, 2 cases of infection, 1 case of seroma, 3 cases of pneumoderm, and no cases of mental nerve injury. The modified TOETVA by dissection of mental nerve is safe and feasible.
探讨在临床实践中通过解剖颏神经对改良经口内镜甲状腺手术前庭入路（TOETVA）的安全性和可行性。回顾性分析2016年7月至2018年6月在湖南省肿瘤医院头颈外科接受改良TOETVA手术的140例患者。其中女性130例，男性10例，年龄（35.4±9.8）岁（范围：11至56岁）。总结手术时间、术中出血量、术后住院时间、术后负压引流情况、术后疼痛评分、术后美容满意度及术后并发症（喉返神经麻痹、甲状旁腺功能减退、感染、皮肤气肿、血清肿及颏神经损伤）。140例患者中，1例转为开放手术。59例行甲状腺切除术，手术时间为（100.8±18.9）分钟。63例行甲状腺切除术及中央区淋巴结清扫术，手术时间为（112.1±16.6）分钟。18例行全甲状腺切除术及中央区淋巴结清扫术，手术时间为（185.3±25.9）分钟。术后住院时间为（3.76±0.98）天。术后引流量为（96.8±36.2）ml。术后24小时疼痛评分为2.66±1.23，术后美容满意度为9.65±0.24。术后并发症中，有3例暂时性喉返神经麻痹，2例永久性喉返神经麻痹，4例暂时性甲状旁腺功能减退但无永久性甲状旁腺功能减退，2例感染，1例血清肿，3例皮肤气肿，无颏神经损伤病例。通过解剖颏神经的改良TOETVA是安全可行的。
