Department of Anatomy, Yonsei University College of Medicine, Seoul, South Korea.
Department of Anatomy and Cell Biology, Dong-A University College of Medicine, Busan, South Korea.
Surg Endosc. 2020 Aug;34(8):3414-3423. doi: 10.1007/s00464-019-07117-x. Epub 2019 Sep 17.
Transoral thyroidectomy is becoming a preferred technique because it has the advantage of not leaving a scar after surgery. However, it is not yet standard because of the anatomic nerve complexity of this oral cavity and difficulty of approach. The aim of this study was to determine the safety zone of a gasless transoral thyroidectomy approach using an anatomical study and to evaluate the efficacy of this approach on clinical application.
Phase 1, twenty unilateral specimens from fresh cadavers underwent staining by the modified Sihler's method to identify nerves around the oral vestibules. Then, the safety zone of the transoral thyroidectomy approach was proposed. Phase 2, a comparative analysis of the clinical outcomes of gasless transoral thyroidectomy through the safety zone versus transcutaneous thyroidectomy approach.
In phase 1, numerous inferior labial branches diverged from the mental nerve and were distributed across the lower lip. In most cases, the most lateral branch reached almost to the corner of the mouth, whereas a nerve-free area was present at the medial region of the lower lip. The suggested safety zone was presented as a trapezoid shape. In phase 2, there were no significant differences in age, mass size, or complications between the two groups. However, the operation time in the transoral thyroidectomy group was longer than in the transcutaneous group (p = 0.001).
Based on the anatomical study, we suggested a safety zone for the gasless transoral thyroidectomy. On application of this safety zone, gasless transoral thyroidectomy is a safe and feasible procedure.
经口甲状腺切除术因其术后无疤痕而成为一种首选技术。然而，由于口腔解剖神经的复杂性和手术入路的困难，它尚未成为标准术式。本研究旨在通过解剖学研究确定无气经口甲状腺切除术入路的安全区域，并评估该入路在临床应用中的疗效。
第 1 阶段，20 例单侧新鲜尸体标本采用改良 Sihler 法染色，以识别口腔前庭周围的神经。然后，提出了经口甲状腺切除术入路的安全区域。第 2 阶段，对经安全区域无气经口甲状腺切除术与经皮甲状腺切除术的临床结果进行了对比分析。
第 1 阶段，大量下唇分支从颏神经分出并分布于下唇。在大多数情况下，最外侧分支几乎可达口角，而下唇内侧区域则存在无神经区。建议的安全区域呈梯形。第 2 阶段，两组间的年龄、肿块大小或并发症无显著差异。然而，经口甲状腺切除术组的手术时间长于经皮组（p=0.001）。
基于解剖学研究，我们为无气经口甲状腺切除术提出了一个安全区域。在应用该安全区域时，无气经口甲状腺切除术是一种安全可行的手术。
