Department of Maxillofacial and Ear, Nose and Throat Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China.
National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China.
Updates Surg. 2023 Jun;75(4):995-1000. doi: 10.1007/s13304-023-01516-5. Epub 2023 Apr 25.
The identification of a lower boundary for the central lymph node (CLN) of the neck in total endoscopic thyroidectomy via the areola approach (ETA) is important for its radical dissection. We found that resection of the suprasternal fossa fat (SFF) was beneficial for exposing the lower boundary and preventing suprasternal swelling after the operation. This retrospective analysis included 470 papillary thyroid carcinoma (PTC) cases, with some treated by unilateral lobectomy, some by central lymph node dissection (CLND) through ETA (n = 193), and the others by conventional open thyroidectomy (COT, n = 277). The main observation indicators included the total number of CLNs, CLND operative time, visualization of the upper pole of the thymus before removing the CLN, and postoperative suprasternal swelling. The SFF retention group and COT group had a similar percentage of women (78.65% vs. 79.42%, P = 0.876) lower than that in the SFF resection group (95.19%, P < 0.001). The percentage of the visualized upper pole of the thymus before CLN removal was notably higher in the SFF resection group than that in the SFF retention group (63.46 vs. 29.21%, P < 0.001) but notably lower than that in the COT group (63.46% vs. 100%, P < 0.001). A total of 43.82% and 23.1% of patients in the SFF retention and COT groups showed suprasternal swelling, respectively. No patient exhibited such swelling in the SFF resection group (23.1% vs. 0, P < 0.001). Resection of SFF in ETA easily identified the lower boundary for CLND and prevented suprasternal fossa swelling.
乳晕入路全腔镜甲状腺切除术（ETA）中中央区淋巴结（CLN）下界的确定对其根治性清扫至关重要。我们发现切除胸骨上窝脂肪（SFF）有利于暴露下界，并预防术后胸骨上肿胀。本回顾性分析纳入了 470 例甲状腺乳头状癌（PTC）患者，其中单侧叶切除术 224 例，ETA 中央区淋巴结清扫术（CLND）193 例，传统开放甲状腺切除术（COT）277 例。主要观察指标包括 CLN 总数、CLND 手术时间、CLN 切除前胸腺上极的可视化程度以及术后胸骨上肿胀。SFF 保留组和 COT 组的女性比例（78.65%比 79.42%，P=0.876）均低于 SFF 切除组（95.19%，P<0.001）。CLN 切除前胸腺上极的可视化率在 SFF 切除组显著高于 SFF 保留组（63.46 比 29.21%，P<0.001），但显著低于 COT 组（63.46 比 100%，P<0.001）。SFF 保留组和 COT 组分别有 43.82%和 23.1%的患者出现胸骨上肿胀，而 SFF 切除组无患者出现胸骨上肿胀（23.1%比 0，P<0.001）。ETA 中切除 SFF 易于确定 CLND 的下界，并预防胸骨上窝肿胀。
