Zhou Shiwei, Li Hui, Wu Peng, Li Wu, Wang Zhiyuan, Zhang Lu, Li Jigang, Peng Xiaowei
Department of Thyroid Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, P.R. China.
Department of Medical Ultrasound, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, P.R. China.
J Otolaryngol Head Neck Surg. 2024 Jan-Dec;53:19160216241301328. doi: 10.1177/19160216241301328.
Injury to the recurrent laryngeal nerve (RLN) and parathyroid glands (PGs) are the most common and serious complications during the transoral endoscopic thyroidectomy vestibular approach (TOETVA), and their exposure and protection are the most important factors affecting the operation time. Here, we report a novel anatomical landmark and surgical method to shorten the operative time and reduce the chance of injury to the RLN and PGs.
According to the different exposure methods of the RLN, patients were divided into the experimental group (from top to bottom, E-group) and the comparison group (from outside to inside, C-group), and 1:1 propensity score-matching (PSM) was performed. The demographics, operative data, postoperative data, and postoperative complications were analyzed by comparing the 2 groups.
After PSM, a total of 206 patients were included. Except for tumor size, there were no significant differences between the 2 groups in terms of sex, age, body mass index, presence of Hashimoto's thyroiditis, or extent of surgery. Compared with the C-group, the operative time, in minutes, of the E-group was significantly shorter (hemithyroidectomy with central neck dissection (CND), C = 111.81 ± 25.83 vs E = 100.52 ± 16.47, = .002 and bilateral thyroidectomy with CND, C = 177.87 ± 36.61 vs E = 156.05 ± 25.60, = .004), the exposure time, in minutes, of the RLN was reduced (hemithyroidectomy with CND, C = 23.31 ± 7.07 vs E = 11.41 ± 2.75, < .001 and bilateral thyroidectomy with CND, C = 45.64 ± 14.84 vs E = 21.76 ± 5.57, < .001). The rate of postoperative temporary PGs and RLN injuries were also reduced (transient hypoparathyroidism, C = 13% vs E = 4%, = .023 and transient RLN palsy, C = 10% vs E = 2%, = .017). In addition, the remaining parameters such as the amount of bleeding, number of lymph node metastases, postoperative hospital stay, visual analog scale pain score, recurrence rate, and other complication rates were not significantly different between the 2 groups.
It is safe and feasible to construct Thyroid-RLN Entry Triangle (Peng's Triangle) for PGs and RLN protection in TOETVA. It is beneficial to shorten the operation time and reduce postoperative complications, both worthy of clinical promotion.
This study was registered at the Chinese Clinical Trial Registry (UIN: ChiCTR2300067673, https://www.chictr.org.cn) in accordance with the World Medical Association's Declaration of Helsinki, 2013.
喉返神经（RLN）和甲状旁腺（PGs）损伤是经口内镜甲状腺手术前庭入路（TOETVA）中最常见且严重的并发症，其显露与保护是影响手术时间的最重要因素。在此，我们报告一种新的解剖标志和手术方法，以缩短手术时间并减少RLN和PGs损伤的几率。
根据RLN的不同显露方法，将患者分为实验组（自上而下，E组）和对照组（由外向内，C组），并进行1:1倾向评分匹配（PSM）。通过比较两组患者的人口统计学数据、手术数据、术后数据及术后并发症情况进行分析。
PSM后，共纳入206例患者。除肿瘤大小外，两组在性别、年龄、体重指数、桥本甲状腺炎的存在情况或手术范围方面无显著差异。与C组相比，E组的手术时间（分钟）显著缩短（单侧甲状腺切除加中央区淋巴结清扫（CND），C = 111.81 ± 25.83 vs E = 100.52 ± 16.47，P = .002；双侧甲状腺切除加CND，C = 177.87 ± 36.61 vs E = 156.05 ± 25.60，P = .004），RLN的显露时间（分钟）减少（单侧甲状腺切除加CND，C = 23.31 ± 7.07 vs E = 11.41 ± 2.75，P < .001；双侧甲状腺切除加CND，C = 45.64 ± 14.84 vs E = 21.76 ± 5.57，P < .001）。术后暂时性PGs和RLN损伤率也降低（暂时性甲状旁腺功能减退，C = 13% vs E = 4%，P = .023；暂时性RLN麻痹，C = 10% vs E = 2%，P = .017）。此外，两组在出血量、淋巴结转移数量、术后住院时间、视觉模拟疼痛评分、复发率及其他并发症发生率等其余参数方面无显著差异。
在TOETVA中构建甲状腺 - RLN入路三角（彭氏三角）用于PGs和RLN的保护是安全可行的。有利于缩短手术时间并减少术后并发症，均值得临床推广。
本研究已按照2013年世界医学协会《赫尔辛基宣言》在中国临床试验注册中心注册（UIN：ChiCTR2300067673，https://www.chictr.org.cn）。
