经胸乳径路联合口腔前庭入路行分化型甲状腺癌根治术的临床分析

Radical resection of differentiated thyroid carcinoma through the oral vestibular approach and the thoracic-breast approach

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（251.0±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。所有患者术后出现不同程度下颌麻木、肿胀及疼痛，术后2例患者出现短暂性低钙血症、2例声音嘶哑、1例乳糜瘘等轻微并发症，均在术后3个月内恢复。美容满意度总体较高，所有患者定期随访半年无复发及转移。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淋巴结清扫效果，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。

Abstract:

Objective To evaluate the clinical utility of the oral vestibular approach and the thoracic-breast approach in radical resection of differentiated thyroid carcinoma (DTC), with emphasis on the completeness of lymph node dissection and the protection of parathyroid glands and recurrent laryngeal nerves. Methods A retrospective analysis was conducted on the clinical data of 13 patients with DTC, who underwent endoscopic thyroid cancer radical resection via the oral vestibular approach and the thoracic-breast approach at Loudi Central Hospital from October 2021 to June 2024. Assessed parameters included operative duration, intraoperative blood loss, the number of lymph node dissections, 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 average surgical duration was (251.0±66.7) min, mean blood loss was (19.6±11.3)mL, and the postoperative hospitalization duration was (6.2±1.1) days. Adequate dissection of both central and lateral cervical lymph nodes was achieved. All patients experienced varying degrees of mandibular numbness, swelling and pain postoperatively. Minor complications occurred postoperatively, including hypocalcemia (2 cases), hoarseness (2 cases), and chyle leakage (1 case), all of which resolved within 3 months after surgery. Overall cosmetic satisfaction was high. Recurrence or metastasis was not observed during short-term follow-up in all patients. Conclusions The oral vestibular approach and the thoracic-breast approach demonstrate 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.