Zhang D G, He G F, Gao L, Li J B, Chu J J, Lu X X
Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
Zhonghua Wai Ke Za Zhi. 2022 Feb 1;60(2):154-158. doi: 10.3760/cma.j.cn112139-20210520-00219.
To examine the safety and feasibility of gasless submental-transoral combined appoach endoscopic thyroidectomy for papillary thyroid carcinoma (PTC). A retrospective analysis of the clinical data of 41 patients with PTC who underwent the gasless submental-transoral combined appoach endoscopic thyroidectomy at the Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from November 2020 to April 2021. There were 5 males and 36 females with the age of (35.0±8.7) years (range: 19 to 58 years). A horizontal incision with a length of 2.0 cm is made under the chin as an observation hole, a 10 mm Trocar and a self-developed retractor are inserted, and two 5 mm longitudinal incisions are made on the labial side in the vestibule of the oral cavity as an operation hole, each inserting a 5 mm Trocar, the operation direction is from the cranial side to the caudal side. The sensation of the lower lip and chin was measured on the first day and one month postoperative. The operation time, hospital stay, the number of lymph nodes dissected and postoperative complications were recorded. Surgical procedures in all cases were successfully completed under endoscopic approach without transfering to open surgery. The operation time was (99±34) minutes (range: 50 to 180 minutes) and the postoperative hospital stay was (3.4±2.2) days (range: 2 to 16 days). The maximum diameter of PTC was (7.6±5.8) mm (range: 2 to 30 mm), and the number of lymph nodes of the central compartment dissection was 6(5) ((IQR)) (range: 1 to 25). The duration of follow-up is 1 month after operation, and the follow-up method is adopted in outpatient clinic. Postoperation complications included 2 cases of transient hypoparathyroidism, One case of recurrent laryngeal nerve injury (continue to follow up to assess whether it is a temporary injury). Postoperative minor chyle leak, seroma, and local redness and swelling in 1 case each were cured after conservative treatment. 1 case of transient minor numbness of the lower lip was observed. No permanent hypoparathyroidism, postoperative bleeding and numbness of the chin was observed. The gasless submental-transoral combined appoach endoscopic thyroidectomy is a feasible approach in selected PTC patients and has clinical application value.
探讨免气腹颏下-经口联合入路内镜甲状腺切除术治疗甲状腺乳头状癌（PTC）的安全性及可行性。回顾性分析2020年11月至2021年4月在浙江大学医学院附属邵逸夫医院头颈外科接受免气腹颏下-经口联合入路内镜甲状腺切除术的41例PTC患者的临床资料。其中男性5例，女性36例，年龄（35.0±8.7）岁（范围：19至58岁）。在颏下作一2.0 cm长的横行切口作为观察孔，插入10 mm套管针及自行研制的牵开器，在口腔前庭唇侧作两条5 mm纵行切口作为操作孔，各插入1枚5 mm套管针，操作方向由头侧向尾侧。分别于术后第1天及1个月测定下唇及颏部感觉。记录手术时间、住院时间、清扫淋巴结数目及术后并发症。所有病例手术均在内镜下顺利完成，未中转开放手术。手术时间为（99±34）分钟（范围：50至180分钟），术后住院时间为（3.4±2.2）天（范围：2至16天）。PTC最大直径为（7.6±5.8）mm（范围：2至30 mm），中央区清扫淋巴结数目为6（5）（四分位间距）（范围：1至25）。术后随访1个月，采用门诊随访方式。术后并发症包括2例暂时性甲状旁腺功能减退，1例喉返神经损伤（继续随访评估是否为暂时性损伤）。术后1例出现少量乳糜漏、1例出现血清肿、1例局部红肿，经保守治疗后治愈。观察到1例下唇短暂轻度麻木。未观察到永久性甲状旁腺功能减退、术后出血及颏部麻木。免气腹颏下-经口联合入路内镜甲状腺切除术在选择合适的PTC患者中是一种可行的手术方式，具有临床应用价值。
