Affiliated Hospital of Putian University, Fujian, China.
Surg Laparosc Endosc Percutan Tech. 2020 Nov 25;31(3):331-336. doi: 10.1097/SLE.0000000000000875.
The objective of this study was to explore the feasibility and safety of transoral endoscopic thyroidectomy via vestibular approach (TOETVA) compared with endoscopic thyroidectomy via bilateral areola approach (ETBAA) in the treatment of patients with benign thyroid nodules.
From January 2017 to December 2018, 60 patients who received TOETVA were enrolled as the research group; 65 patients who underwent ETBAA were included as the control group. A retrospective study was performed using the clinical data for these cases. All patients were diagnosed with benign nodules by preoperative examinations. Parameters including surgical trauma, complications, cosmetic satisfaction, and postoperative discomfort were compared between the 2 groups.
All operations were completed without incident. There were significant differences in operation time (137.8±18.7 vs. 95.7±17.2 min), intraoperative blood loss (16.8±9.1 vs. 24.6±16.6 mL), drainage volume (123.1±20.9 vs. 153.6±40.2 mL), C-reactive protein level (7.2±5.2 vs. 9.0±4.7 mg/L), drainage time (3.2±0.6 vs. 3.9±1.3 d), postoperative hospital stay (3.3±0.8 vs. 4.1±1.5 d), and sense of skin tension on the neck (0% vs. 10.8%) between the TOETVA and ETBAA groups (P<0.05). There were no significant differences in pain score, incidence of recurrent laryngeal nerve injury, transient hypoparathyroidism, infection, inadvertent parathyroidectomy, or swallow discomfort between the 2 groups. The cosmetic satisfaction score in the TOETVA group was significantly higher than that in the ETBAA group at 1 month after surgery (9.8±0.5 vs. 9.4±0.9, P<0.05), but at 3 months after the operation, the difference was not statistically significant.
TOETVA was accompanied by less surgical trauma and skin tension on the neck than ETBAA, and the cosmetic effect of this approach was better than that of ETBAA in the early postoperative period. TOETVA for benign thyroid nodules is safe and feasible. However, there are disadvantages with TOETVA, such as a long surgical period. More cases and further research are needed to delve further into this approach.
本研究旨在探讨经口内镜甲状腺手术（TOETVA）经前庭入路与内镜甲状腺手术经乳晕双侧入路（ETBAA）治疗良性甲状腺结节的可行性和安全性。
自 2017 年 1 月至 2018 年 12 月，我们纳入了 60 例行 TOETVA 的患者作为研究组；纳入了 65 例行 ETBAA 的患者作为对照组。回顾性分析这些患者的临床资料。所有患者术前检查均诊断为良性结节。比较两组患者的手术创伤、并发症、美容满意度和术后不适等参数。
所有手术均顺利完成。TOETVA 组的手术时间（137.8±18.7 分钟比 95.7±17.2 分钟）、术中出血量（16.8±9.1 毫升比 24.6±16.6 毫升）、引流量（123.1±20.9 毫升比 153.6±40.2 毫升）、C 反应蛋白水平（7.2±5.2 毫克/升比 9.0±4.7 毫克/升）、引流时间（3.2±0.6 天比 3.9±1.3 天）、术后住院时间（3.3±0.8 天比 4.1±1.5 天）、颈部皮肤紧张感（0%比 10.8%）差异均有统计学意义（P<0.05）。两组间疼痛评分、喉返神经损伤发生率、暂时性甲状旁腺功能减退症、感染、意外甲状旁腺切除、吞咽不适等并发症发生率差异均无统计学意义。TOETVA 组术后 1 个月的美容满意度评分明显高于 ETBAA 组（9.8±0.5 比 9.4±0.9，P<0.05），但术后 3 个月差异无统计学意义。
与 ETBAA 相比，TOETVA 手术创伤更小，颈部皮肤紧张感更轻，术后早期美容效果优于 ETBAA。TOETVA 治疗良性甲状腺结节是安全可行的。但 TOETVA 也存在手术时间长等缺点，需要更多病例和进一步研究来深入探讨。
