Department of Thyroid and Breast Surgery, The First College of Clinical Science of Three Gorges University, Yiling Road 183, Yichang, Hubei, 443003, China.
Department of Thyroid and Breast Surgery, Shanghai Jiao Tong University Affiliated with the Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China.
Surg Endosc. 2020 Dec;34(12):5274-5282. doi: 10.1007/s00464-019-07314-8. Epub 2019 Dec 13.
Transoral endoscopic thyroid surgery via the vestibular approach (TOETVA) has been gradually accepted worldwide due to its scar-free effect on the neck. Even central cervical lymphadenectomy has been performed in some cases of papillary thyroid carcinoma (PTC). However, there are few reports involving lateral neck dissection with TOETVA. In this study, we attempted to perform selective lateral neck dissection (SLND) for PTC via a transoral vestibular approach.
This prospective study was conducted from January 2016 to December 2018 in twenty PTC patients with unilateral T1 tumors without capsular invasion and patients with abnormal level III and IV lymph nodes who underwent SLND via a transoral vestibular approach.
Endoscopic surgery was successfully accomplished in all 20 PTC patients. The mean age was 29.2 ± 5.5 (20-41) years. The mean operation time was 146.0 ± 18.7 (114-193) min. The average postoperative hospital stay was 6.8 ± 1.3 (5-10) days. The mean number of removed nodes was 7.4 ± 2.5 (4-12) in the central neck and 10.9 ± 2.8 (6-16) in the lateral neck, and the positive yield amounts were 2.0 ± 1.2 (0-4) and 2.7 ± 1.9 (0-6), respectively. No major complications occurred except for 1 case of transient unilateral recurrent laryngeal nerve palsy and two cases of effusion in the operative area. No evidence of persistent or recurrent disease was observed in these patients during a mean follow-up of 24.3 ± 9.1 (6-36) months. The cosmetic results and protection of personal privacy of this procedure were excellent.
Endoscopic SLND via the transoral vestibular approach is feasible, safe, and effective for selected PTCs. A multicenter large comparative study is necessary.
经口内镜甲状腺手术（TOETVA）通过颈部无疤痕的效果已在全球范围内逐渐被接受。即使在某些甲状腺乳头状癌（PTC）病例中也进行了中央颈部淋巴结清扫术。然而，涉及经口前庭入路的侧颈部淋巴结清扫术（SLND）的报道很少。在这项研究中，我们尝试通过经口前庭入路进行选择性侧颈部淋巴结清扫术（SLND）治疗 PTC。
这项前瞻性研究于 2016 年 1 月至 2018 年 12 月在 20 例患有单侧 T1 肿瘤且无包膜侵犯的 PTC 患者以及伴有异常 III 级和 IV 级淋巴结的患者中进行，这些患者通过经口前庭入路进行 SLND。
所有 20 例 PTC 患者均成功完成了内镜手术。患者平均年龄为 29.2±5.5（20-41）岁。平均手术时间为 146.0±18.7（114-193）min。平均术后住院时间为 6.8±1.3（5-10）天。中央颈部切除的平均淋巴结数为 7.4±2.5（4-12）个，侧颈部为 10.9±2.8（6-16）个，阳性检出量分别为 2.0±1.2（0-4）和 2.7±1.9（0-6）。除 1 例暂时性单侧喉返神经麻痹和 2 例手术部位积液外，无其他重大并发症。在平均 24.3±9.1（6-36）个月的随访期间，这些患者均未发现持续性或复发性疾病的证据。该手术的美容效果和对个人隐私的保护均极佳。
经口前庭入路内镜 SLND 对于选择性 PTC 是可行、安全且有效的。需要进行多中心大样本的对比研究。
