中国现代手术学杂志2025，Vol.29Issue(3)：171-177,7.DOI:10.16260/j.cnki.1009-2188.2025.03.001
经颏下前庭入路腔镜与开放手术行甲状腺乳头状癌根治术的疗效比较
Effect comparison between transoral endoscopic thyroidectomy via submental-vestibular approach ver-sus open radical thyroidectomy for papillary thyroid carcinoma
摘要
Abstract
Objective To compare the clinical efficacy of transoral endoscopic thyroidectomy via the submental-vestibular approach(TOETSMVA)and conventional open thyroidectomy for the treatment of papillary thyroid carcinoma(PTC),and to evaluate the operative characteristics,oncological safety,and cosmetic outcomes.Methods A retrospective analysis was conducted on the clinical data of 100 patients with PTC treated between September 2021 and March 2024.Based on the surgical approach,the patients were divided into the endoscopic group(n=38)and the open surgery group(n=62).The endoscopic group underwent TOETSMVA,while the open surgery group received conventional open radical thyroidectomy.Perioperative out-comes,postoperative complications,cosmetic results,and quality of life were compared between the two groups.Results Compared with the open group,the operation time was significantly longer[(126.5±60.1)min vs.(67.7±23.9)min,P＜0.001],the intraoperative blood loss was lower[(13.5±8.9)mL vs.(16.9±5.7)mL,P＜0.05],and the number of lymph nodes dissected was greater[(9.3±3.5)vs.(6.2±5.8),P＜0.01]in the endoscopic group.The postoperative inflammatory indicators(WBC and CRP)were higher in the endoscopic group than in the open group(P＜0.05).There was no significant difference in the incidence of intraoperative recurrent laryngeal nerve monitoring signal attenuation,parathyroid autotransplantation,postoperative hospital stay,drainage volume,or drainage duration between the two groups(P＞0.05).No wound infection,perma-nent recurrent laryngeal nerve injury,or permanent hypoparathyroidism were observed in either group after surgery.There was no significant difference in the incidence of temporary recurrent laryngeal nerve injury,temporary hypoparathyroidism,lymphatic fistula,postoperative coughing on fluid intake,subcutaneous ecchymosis,oral commissure injury,hematoma,paresthesia,or overall complication rate between the two groups(P＞0.05).All patients were followed up for 12 months,with no recurrence or metastasis observed.The endoscopic group exhibited significantly lower Vancouver Scar Scale(VSS)scores at 3 months postoperatively(3.7±0.9 vs.8.1±1.6,P＜0.001)and higher EORTC QLQ-C30 scores at 1 year postoperatively(80.4±7.1 vs.64.3±10.9,P＜0.001).Conclusions TOETSMVA achieves comparable oncological outcomes while reducing intra-operative bleeding and enhancing the efficiency of lymph node dissection through techniques such as tunneling dissection and optimized visualization under direct vision.The concealed incision significantly improves post-operative cosmetic outcomes and patient quality of life.However,surgeons must overcome challenges such as a restricted operating space and a long and steep learning curve.The procedure is particularly suitable for young patients with high cosmetic demands.关键词
甲状腺乳头状癌/腔镜甲状腺癌根治术/经颏下前庭入路/开放手术/中央区淋巴结清扫Key words
papillary thyroid carcinoma/endoscopic thyroidectomy/submental-vestibular approach/open surgery/central lymph node dissection引用本文复制引用
陈念,倪志强,董宇轩,徐添旺,彭书旺..经颏下前庭入路腔镜与开放手术行甲状腺乳头状癌根治术的疗效比较[J].中国现代手术学杂志,2025,29(3):171-177,7.基金项目
湖南省教育厅科学研究项目(2022B0402) （2022B0402）
