Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
College of Medicine, Zhejiang University, Hangzhou, China.
Front Endocrinol (Lausanne). 2024 Apr 17;15:1302510. doi: 10.3389/fendo.2024.1302510. eCollection 2024.
This study aimed to introduce a new modified en-bloc resection method and evaluate its feasibility and safety in endoscopic thyroid surgery via bilateral areolar approach (BAA).
Papillary thyroid carcinoma (PTC) patients who underwent lobectomy and ipsilateral central node dissection (CND) via the BAA approach were retrospectively reviewed. Their clinical characteristics and outcomes were evaluated, including operative duration, lymph node yield (LNY), surgical complications, recurrence rate, and metastasis rate, over a ten-year follow-up period. Simultaneous lobectomy and CND were performed in the modified en-bloc group, whereas lobectomy was performed first, followed by CND in the conventional group.
The study included 108 patients in the modified en-bloc group and 213 in the conventional group. There were no significant differences in gender, age, tumor locations, tumor dominant nodule size, or the incidence of concomitant Hashimoto thyroiditis when comparing clinicopathologic characteristics. The comparison of operative duration (P = 0.14), blood loss (P = 0.13), postoperative hospital stay (P = 0.58), incidence of transient vocal cord paralysis (P = 0.90) and hypocalcemia (P = 0.60) did not show any differences. The mean LNY achieved in the central compartment of the modified en-bloc group (7.5 ± 4.5) was significantly higher than that in the conventional group (5.6 ± 3.6). Two patients in the modified en-bloc group and two in the conventional group experienced metastasis after surgery during the ten-year follow-up (1.8% vs. 0.9%, P = 0.60). The learning curve analysis showed a significant decrease in operative duration after the 25-35 cases for modified en-bloc resection.
The modified en-bloc resection method in endoscopic thyroid surgery via BAA is a technically feasible and safe procedure with excellent cosmetic outcomes for selective PTC patients.
本研究旨在介绍一种新的改良整块切除术方法，并通过双侧乳晕入路（BAA）评估其在内镜甲状腺手术中的可行性和安全性。
回顾性分析了经 BAA 行甲状腺叶切除术和同侧中央淋巴结清扫术（CND）的甲状腺乳头状癌（PTC）患者的临床特征和结果。在 10 年的随访期间，评估了包括手术时间、淋巴结收获量（LNY）、手术并发症、复发率和转移率在内的指标。在改良整块切除组中同时进行了双侧叶切除术和 CND，而在常规组中首先进行了甲状腺叶切除术，然后进行了 CND。
改良整块切除组纳入 108 例患者，常规组纳入 213 例患者。两组患者的性别、年龄、肿瘤位置、肿瘤主结节大小或合并桥本甲状腺炎的发生率在临床病理特征方面无显著差异。手术时间（P = 0.14）、出血量（P = 0.13）、术后住院时间（P = 0.58）、暂时性声带麻痹的发生率（P = 0.90）和低钙血症的发生率（P = 0.60）无显著差异。改良整块切除组中央区的平均 LNY（7.5 ± 4.5）显著高于常规组（5.6 ± 3.6）。改良整块切除组有 2 例患者和常规组有 2 例患者在 10 年随访期间发生了术后转移（1.8%比 0.9%，P = 0.60）。改良整块切除术的学习曲线分析显示，手术时间在完成 25-35 例后显著下降。
通过 BAA 的内镜甲状腺手术中改良整块切除术是一种技术可行且安全的方法，对于选择性 PTC 患者具有良好的美容效果。
