单侧腋窝双侧乳晕入路机器人手术与开放手术治疗甲状腺癌的疗效及安全性的对照研究

刘海峰; 张晔; 杜俊泽; 曾令娟; 钟玲; 张毅; 姜军; 范林军

doi:10.16016/j.2097-0927.202110187

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单侧腋窝双侧乳晕入路机器人手术与开放手术治疗甲状腺癌的疗效及安全性的对照研究

临床医学 | 更新时间：2026-01-09

- 单侧腋窝双侧乳晕入路机器人手术与开放手术治疗甲状腺癌的疗效及安全性的对照研究
- Efficacy and safety of unilateral axilla-bilateral areola approach for robotic thyroidectomy versus open surgery for thyroid cancer
- 陆军军医大学学报 2022年44卷第2期页码：168-174
- 作者机构：
  
  1.400038 重庆，陆军军医大学(第三军医大学)第一附属医院乳腺甲状腺外科
  2.041000 山西临汾，临汾市中心医院乳腺甲状腺外科
- 作者简介：
  
  [范林军，E-mail: flj212@126.com FAN Linjun, E-mail: flj212@126.com
- 基金信息：
  
  重庆市技术创新与应用发展专项资助(cstc2019jscx-msxmX0284)
- DOI：10.16016/j.2097-0927.202110187
  中图分类号： R195.4;R730.56;R736.1
- 收稿：2021-10-28，
  
  修回：2021-11-04，
  
  纸质出版：2022-01-30
- 稿件说明：
移动端阅览
刘海峰, 张晔, 杜俊泽, 等. 单侧腋窝双侧乳晕入路机器人手术与开放手术治疗甲状腺癌的疗效及安全性的对照研究[J]. 陆军军医大学学报, 2022,44(2):168-174.

Haifeng LIU, Ye ZHANG, Junze DU, et al. Efficacy and safety of unilateral axilla-bilateral areola approach for robotic thyroidectomy versus open surgery for thyroid cancer[J]. Journal of Army Medical University, 2022, 44(2): 168-174.
刘海峰, 张晔, 杜俊泽, 等. 单侧腋窝双侧乳晕入路机器人手术与开放手术治疗甲状腺癌的疗效及安全性的对照研究[J]. 陆军军医大学学报, 2022,44(2):168-174. DOI： 10.16016/j.2097-0927.202110187.

Haifeng LIU, Ye ZHANG, Junze DU, et al. Efficacy and safety of unilateral axilla-bilateral areola approach for robotic thyroidectomy versus open surgery for thyroid cancer[J]. Journal of Army Medical University, 2022, 44(2): 168-174. DOI： 10.16016/j.2097-0927.202110187.

摘要

目的

对比评价单侧腋窝双侧乳晕入路(unilateral axilla-bilateral areola

UABA)机器人手术与传统开放手术治疗甲状腺癌的疗效及安全性。

方法

采用回顾性病例对照研究设计，收集2018年1月至2020年5月在陆军军医大学第一附属医院乳腺甲状腺外科确诊为甲状腺癌并接受甲状腺全切加双侧中央区淋巴结清扫术式的患者229例。其中机器人手术(机器人组)105例，传统开放手术(开放组)124例。随访时间12~36个月。比较两组患者术后甲状旁腺功能减退情况、喉返神经损伤发生情况、手术时间、术中出血量、术后3 d引流量、患者术后满意度等指标。

结果

与开放组比较，机器人组术后暂时性甲状旁腺功能减退发生率(28.57%

64.52%，

0.001)及永久性甲状旁腺功能减退发生率(0.00%

5.65%，

=0.016)明显降低；术后永久性喉返神经损伤发生率(0.00%

5.65%，

=0.016)明显降低。机器人组术后患者满意度(100.0%)明显高于开放组(87.1%，

0.001)。但机器人组手术时间及术后3 d引流量明显高于开放组；术中出血量、切除淋巴结数、术后甲状腺球蛋白水平两组无明显差异。两组患者术后随访期间均无复发转移。

结论

单侧腋窝双侧乳晕入路机器人手术治疗甲状腺癌与开放手术的疗效相同，在甲状旁腺和喉返神经保护方面更加安全，并能更好地保护患者颈部外观。

Abstract

Objective

To compare the efficacy and safety of unilateral axilla-bilateral areola approach (UABA) for robotic thyroidectomy with conventional open surgery in thyroid cancer patients.

Methods

We retrospectively analyzed the clinical data of 229 patients who were diagnosed with thyroid cancer and underwent total thyroidectomy plus bilateral central node dissection in the Department of Breast and Thyroid Surgery

First Affiliated Hospital of Army Medical University from January 2018 to May 2020

including 105 cases undergoing robotic surgery (robotic group) and 124 cases undergoing conventional open surgery (open group). All of them were followed up for 12 to 36 months. The hypoparathyroidism

recurrent laryngeal nerve injury

operation time

intraoperative blood loss

drainage volume within postoperative 3 days

postoperative complications and patient satisfaction with neck appearance were recorded and compared between 2 groups.

Results

The incidences of transient hypoparathyroidism (28.57%

64.52%

=0.000) and permanent hypoparathyroidism (0

5.65%

=0.016) were significantly lower in the robot group than the open group. So was the rate of permanent recurrent laryngeal nerve injury (0

5.65%

=0.016). The patients in the robotic group obtained significantly higher satisfaction than those of the open group (100%

87.1%

0.001). However

operation time (156.57±37.87

113.98±46.03 min

0.001) was longer

and drainage volume within 3 d postoperatively (141.57±43.16

120.79±49.96 mL

0.001) was statistically larger in the robotic group than the open group. There were no significant differences in intraoperative blood loss (50.31±23.37

50.48±13.67 mL

=0.455)

number of removed lymph nodes (11.23±6.77

12.97±6.77

=0.055) and postoperative thyroglobulin level (1.01±5.36

1.43±8.47 ng/mL

=0.330) between the 2 groups. No recurrence or metastasis was observed in the 2 groups during the follow-up period.

Conclusion

Compared with open surgery

unilateral axilla-bilateral areola approach for robotic surgery shows similar therapeutic effect

but it can better protect the parathyroid gland and recurrent laryngeal nerve and preserve the neck appearance by super-meticulous capsular dissection.

关键词

Keywords

references

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