目的 探讨使用自制新型免充气拉钩行经口联合颏下入路腔镜甲状腺手术(transoral endoscopic thyroidectomy via submental and vestibular approach，TOETSMVA)的安全性。方法 回顾性分析2021年1月～2022年6月119例单侧叶甲状腺肿瘤手术资料，其中37例使用新型免充气拉钩行免充气TOETSMVA(免充气组)，37例行充气TOETSMVA(充气组)，45例行传统颈前开放甲状腺手术(开放组)。比较3组手术指标、术后并发症、患者对切口满意度的差异。结果 与开放组相比，免充气组手术时间长[(131。0±20。1)min vs。(81。1±15。7)min，P=0。000]，但术中出血量少[19(15，27)ml vs。30(25，37)ml，P=0。000]，术后第1天疼痛评分低[(4。8±2。1)分vs。(6。4±1。9)分，P=0。000]，患者对切口满意度高(非常不满意、不满意、满意、较为满意、非常满意的例数分别为0、0、6、16、15 vs。4、3、19、17、2，P=0。000)。与充气组相比，免充气组手术时间短[(131。0±20。1)min vs。(141。8±22。9)min，P=0。019]，术中出血量、术后第1天疼痛评分、患者对切口满意度差异无统计学意义(P＞0。05)。3组淋巴结清扫数量、术后总引流量、术后1天甲状旁腺激素(parathyroid hormone，PTH)水平差异无统计学意义(P＞0。05)。开放组术后出血1例，免充气组颈部皮下瘀斑1例、声音嘶哑1例，3组均无气管食管损伤、严重皮下气肿、高碳酸血症、气体栓塞等并发症。结论 新型免充气拉钩在TOETSMVA术中能够有效地维持空间，与传统颈前开放甲状腺手术和常规充气TOETSMVA相比，手术安全性好。
Application of a New Type Non-inflatable Retractor in Transoral Endoscopic Thyroidectomy via Submental and Vestibular Approach
Objective To investigate the safety of using a self-made new type non-inflatable retractor for transoral endoscopic thyroidectomy via submental and vestibular approach(TOETSMVA).Methods A retrospective analysis was conducted on the surgical records of 119 cases of unilateral thyroid lobe tumor from January 2021 to June 2022.Among them,37 cases underwent non-inflatable TOETSMVA by using a new type non-inflatable retractor(non-inflatable group),37 cases underwent traditional inflatable TOETSMVA(inflatable group),and 45 cases underwent traditional open anterior cervical thyroid surgery(open group).The differences in surgical indicators,postoperative complications,and patient satisfaction with incision were compared among the three groups.Results Compared with the open group,the non-inflatable group had longer operation time[(131.0±20.1)min vs.(81.1±15.7)min,P=0.000],but less intraoperative blood loss[19(15,27)ml vs.30(25,37)ml,P=0.000],lower pain score on the first day after surgery[(4.8±2.1)points vs.(6.4±1.9)points,P=0.000],and higher patient's satisfaction with the incision(the number of cases of very dissatisfied,dissatisfied,satisfied,comparatively satisfied,and very satisfied were 0,0,6,16,15 vs.4,3,19,17,2,P=0.000).Compared with the inflatable group,the non-inflatable group had shorter surgical time[(131.0±20.1)min vs.(141.8±22.9)min,P=0.019],and there were no statistically significant differences in intraoperative bleeding volume,pain score on the first day after surgery,and patient satisfaction with the incision(P＞0.05).There were no statistically significant differences in the number of lymph node dissection,total postoperative drainage volume,and parathyroid hormone(PTH)levels on the first day after surgery among the three groups(P＞0.05).Postoperative bleeding occurred in 1 case in the open group,and 1 case of hoarseness and 1 case of subcutaneous ecchymosis of the neck were noted in the non-inflatable group.No tracheoesophageal injury,severe subcutaneous emphysema,hypercapnia,or gas embolism happened among the three groups.Conclusions The new type non-inflatable retractor can effectively maintain space during TOETSMVA surgery.Compared with traditional open anterior cervical thyroid surgery and conventional inflatable TOETSMVA,it has better surgical safety.
万方数据
维普
