中国普通外科杂志2023，Vol.32Issue(11)：1677-1686,10.DOI:10.7659/j.issn.1005-6947.2023.11.006
机器人辅助超精细被膜解剖技术在甲状腺癌手术中的应用:附1 045例报告
The application of robot-assisted super-meticulous capsular dissection in thyroid cancer surgery:a report of 1 045 cases
摘要
Abstract
Background and Aims:Due to the 3D visualization and flexible intra-articular elements of robotic surgical devices,the application of robotic surgical systems in thyroid surgery has expanded the scope of laparoscopic surgery.This study was designed to provide a summary and analysis of patients with thyroid cancer(TC)undergoing robot-assisted radical thyroidectomy with super-meticulous capsular dissection(SMCD)technique in the authors'hospital,to evaluate the efficacy and safety of implementing the SMCD technique with robotic assistance. Methods:The clinical data of 1 045 TC patients who underwent robotic-assisted radical thyroidectomy with SMCD technique in the First Affiliated Hospital of the Army Military Medical University from June 2018 to May 2022 were retrospectively analyzed. Results:All 1 045 patients successfully underwent robotic surgery.Among them,214 cases(20.5％)underwent unilateral lobectomy with unilateral central lymph node dissection,342 cases(32.7％)underwent total thyroidectomy with unilateral central lymph node dissection,317 cases(30.3％)underwent total thyroidectomy with bilateral central lymph node dissection,157 cases(15.0％)underwent unilateral lateral neck dissection and 15 cases(1.4％)underwent bilateral lateral neck dissection.Except for 172 cases(16.5％)who underwent lateral neck dissection via the bilateral axillo-breast approach(BABA),the remaining 873 cases(83.5％)were completed via the unilateral axilla-bilateral areola approach(UABA),with an average operative time of(151.74±59.62)min.Parathyroid transplantation was performed in 38 cases(3.6％),and 336 cases(32.2％)underwent postoperative 131I treatment.After operation,temporary hypoparathyroidism occurred in 245 cases(23.4％),and permanent hypoparathyroidism occurred in 7 cases(0.7％);temporary hoarseness occurred in 4 cases(0.4％);local recurrence occurred in 3 cases(0.3％).Both univariate and multivariate analyses showed that the extent of surgery was a factor for the occurrence of temporary hypoparathyroidism(HR=1.51,95％CI-0.90-2.49,P＜0.001;HR=1.20,95％CI=1.00-1.43,P=0.049). Conclusion:Robotic surgery for TC is safe and thorough,and the UABA approach is capable of performing robotic total thyroidectomy plus central compartment clearance,while the BABA approach is a more suitable choice for lateral lymph node dissection.The application of SMCD with robotic assistance helps preserve parathyroid function and reduces the occurrence of permanent hypoparathyroidism.关键词
甲状腺肿瘤/甲状腺切除术/机器人手术/甲状旁腺功能减退症Key words
Thyroid Neoplasms/Thyroidectomy/Robotic Surgical Procedures/Hypoparathyroidism分类
医药卫生引用本文复制引用
覃湘泉,赵晶晶,罗佳,曾令娟,范林军..机器人辅助超精细被膜解剖技术在甲状腺癌手术中的应用:附1 045例报告[J].中国普通外科杂志,2023,32(11):1677-1686,10.基金项目
重庆市技术创新与应用发展专项基金资助项目(cstc2019jscx-msxmX0284) （cstc2019jscx-msxmX0284）
重庆市英才创新创业领军人才基金资助项目[CQYC202103078]. （）
