经胸乳径路联合口腔前庭入路行分化型甲状腺癌根治术

Combined Breast Areola and Oral Vestibular Approach for Radical Resection of Differentiated Thyroid Carcinoma

摘要:

目的 探讨经胸乳径路联合口腔前庭入路在分化型甲状腺癌（DTC）根治术中的临床应用价值，重点评估其在淋巴结清扫彻底性、甲状旁腺及喉返神经保护方面的安全性与有效性。 方法 回顾性分析2021年10月—2024年6月在娄底市中心医院接受经胸乳径路联合口腔前庭入路腔镜甲状腺癌根治术的13例DTC患者的临床资料，包括手术时间、术中出血量、清扫淋巴结数目、术后并发症及美容满意度等指标。所有数据使用SPSS 22.0软件进行统计学分析。 结果 全部手术顺利完成，无中转开放。平均手术时间为（251±66.7）min，出血量为（19.6±11.3）mL，术后住院时间为（6.2±1.1）d。中央区及颈侧区淋巴结均实现充分清扫。术后出现短暂性低钙血症（2例）、声音嘶哑（2例）、乳糜瘘（1例）等轻微并发症，均在术后3个月内恢复。美容满意度总体较高，所有患者短期随访期间无复发及转移。 结论 经胸乳径路联合口腔前庭入路在DTC根治术中具有良好的安全性及清扫效果，术后并发症少，美容效果佳，是具有推广前景的腔镜手术方式之一。 关键词：甲状腺癌；腔镜手术；联合入路；颈部淋巴结清扫；微创治疗

Abstract:

Abstract Objective  To evaluate the clinical utility of the combined breast areola and oral vestibular approach in radical resection of differentiated thyroid carcinoma (DTC), with a focus on the safety and efficacy regarding completeness of lymph node dissection, as well as protection of the parathyroid glands and recurrent laryngeal nerves. Methods  A retrospective analysis was conducted on clinical data from 13 DTC patients who underwent endoscopic thyroid cancer radical resection via the combined breast areola and oral vestibular approach at Loudi Central Hospital between October 2021 and June 2024. Assessed parameters included operative time, intraoperative blood loss, number of lymph nodes dissected, postoperative complications, and cosmetic satisfaction. All data were statistically analyzed using SPSS 22.0 software. Results  All surgeries were successfully completed without conversion to open surgery. The mean operative time was 251±66.7 min, mean blood loss was 19.6±11.3 mL, and mean postoperative hospital stay was 6.2±1.1 days. Adequate dissection of both central and lateral cervical lymph nodes was achieved. Transient mild complications occurred, including hypocalcemia (2 cases), hoarseness (2 cases), and chyle leakage (1 case), all of which resolved within 3 months postoperatively. Overall cosmetic satisfaction was high, and no recurrence or metastasis was observed during short-term follow-up in all patients. Conclusion  The combined breast areola and oral vestibular approach demonstrates favorable safety and dissection efficacy in radical resection of DTC, with low postoperative complication rates and excellent cosmetic outcomes. It represents a promising endoscopic surgical modality worthy of broader application. Keywords: Thyroid carcinoma; Endoscopic surgery; Combined approach; Cervical lymph node dissection; Minimally invasive treatment