摘要
Abstract
Background and Aims:Transoral endoscopic thyroidectomy vestibular approach(TOETVA)has gained increasing popularity due to its scarless appearance and convenience in central compartment lymph node dissection.However,the conventional approach using a 10-mm endoscope and relatively large vestibular incisions often leads to traction-related injuries of the lips and chin.To minimize maxillofacial trauma,a 5-mm endoscope-based small-incision TOETVA(SITOETVA)has been introduced.Yet the smaller trocar limits the initial working space,making trocar convergence difficult and increasing bleeding risk.This study compares the single-tunnel transmural puncture method with the multi-tunnel transcavity puncture method to determine an optimized cavity-creation strategy for SITOETVA.
Methods:A retrospective analysis was conducted on 60 patients who underwent SITOETVA between May and September 2024,all operated on by the same surgeon.Among them,30 patients underwent cavity creation using the single-tunnel transmural puncture method(observation group),and the remaining 30 patients underwent cavity creation using the multi-tunnel transcavity puncture method(control group).The two groups were compared in terms of cavity-creation time,operative time,initial-space bleeding rate,intraoperative blood loss,postoperative drainage volume,number of central compartment lymph nodes dissected,and postoperative length of hospital stay.
Results:Baseline characteristics were comparable between the two groups(all P>0.05).The observation group demonstrated significantly shorter cavity-creation time[(14.5±2.3)min vs.(24.9±5.7)min],shorter operative time[(81.5±17.6)min vs.(96.8±15.6)min],lower intraoperative blood loss[(2.5±1.4)mL vs.(4.8±3.5)mL],and markedly reduced initial space bleeding rate(3.33%vs.33.33%)compared with the control group(all P<0.05).No significant differences were observed in postoperative drainage volume,lymph node yield,or hospital stay(all P>0.05).No cases of dyspnea,hoarseness,or limitation of lower-lip movement were observed in either group.During follow-up,no cases of recurrence or distant metastasis were detected in either group,and sensory function of the lips and chin recovered within 2-4 weeks without long-term functional impairment.
Conclusion:The single-tunnel transmural puncture technique effectively reduces bleeding risk,simplifies trocar convergence,and shortens operative time in SITOETVA.It represents a practical and streamlined modification of the cavity-creation procedure and has strong clinical applicability.关键词
甲状腺肿瘤/甲状腺切除术/口腔前庭入路/建腔Key words
Thyroid Neoplasms/Thyroidectomy/Oral Vestibular Approach/Cavity Creation分类
医药卫生
