经口联合颌下腔镜入路甲状腺手术的临床效果：附31例报告

背景与目的 全球甲状腺癌发病率不断增高，临床实践中腔镜甲状腺手术的需求逐渐增大。在不同甲状腺手术入路中，经口前庭入路腔镜甲状腺手术（TOETVA）最符合经自然腔道内镜手术理念，而TOETVA面临比较明显的并发症，本研究旨在探讨经口联合颌下入路腔镜甲状腺手术（ETOSA）在甲状腺乳头状癌手术中的应用效果。方法 回顾2022年3月—2022年6月在中南大学湘雅医院甲状腺外科接受ETOSA手术的31例甲状腺乳头状癌患者的临床资料，分析手术时间、术中出血量、术后引流量、术后引流时间、术后住院时间、术后病理结果、颈部美容评分、颏下感觉异常评分、术后疼痛评分以及术后并发症的发生及恢复情况。结果 31例患者均顺利完成ETOSA手术，无1例患者中转开放。平均手术时间（145.23±35.91）min；术中平均出血量（11.13±4.78）mL；术后第1天引流量为（50.97±26.25）mL；第2天引流量为（22.74±15.10）mL；术后平均住院时间为（2.19±0.47）d；清扫的中央区淋巴结数目为（7.52±4.34）枚。所有患者均未出现声带麻痹、颏神经损伤、术后感染、吞咽不适、口角撕裂以及下唇肿胀。仅有2例患者出现暂时性甲旁减以及1例患者出现颈前皮肤穿孔。所有患者均无明显下唇黏膜和皮肤感觉障碍，且手术美容效果良好，所有患者对术后颌下两个5 mm切口的恢复情况较满意。结论 ETOSA手术是一种安全且可行的术式，减少了颏神经损伤、嘴角撕裂等风险同时避免了潜在的器械相互干扰，有一定的临床应用价值。

Clinical efficacy of endoscopic thyroidectomy via oral vestibule and submandibular approach: a report of 31 cases

Background and Aims The incidence of thyroid carcinoma is continuously rising throughout the world. In clinical practice, the demand for endoscopic thyroidectomy has also increased. Among various approaches of endoscopic thyroidectomy, transoral endoscopic thyroidectomy vestibular approach (TOETVA) meets the concept of natural orifice transluminal endoscopic surgery (NOTES) better than other approaches. However, TOETVA is obviously associated with complications that may greatly affect patients'' quality of life. Therefore, this study was conducted to evaluate the application efficacy of endoscopic thyroidectomy via oral vestibule and submandibular approach (ETOSA) in the treatment papillary thyroid carcinoma (PTC).Methods The clinical data of a total of 31 PTC patients undergoing ETOSA surgery in Xiangya Hospital from March 2022 to June 2022 were reviewed. The operative time, blood loss, postoperative drainage, length of postoperative hospitalization, pathological results, and the scores for neck cosmetic appearance, sensation of the submental area and postoperative pain as well as postoperative complications were analyzed.Results ETOSA procedure was successfully completed in all patients and none of them required a conversion to open surgery. The average operative time was (145.23±35.91) min, the mean intraoperative blood loss was (11.13±4.78) mL, the average drainage volumes were (50.97±26.25) mL on postoperative day (POD) 1 and (22.74±15.10) mL on POD 2 respectively, the average length of postoperative hospitalization was (2.19±0.47) d, and the average number of dissected central lymph node was 7.52±4.34. Complications such as postoperative hoarse voice, mental nerve injury, surgical area infection, swallowing discomfort, cracked corners of the mouth and swelling of the lower lip occurred in none of the patients. Only 2 cases had temporary hyperparathyroidism and 1 case had cervical skin perforation. All patients had no obvious lower lip and skin paresthesia with good cosmetic outcomes. Patients were satisfied with the recovery of the two 5-mm submental incisions.Conclusion ETOSA is a safe and feasible procedure, which can reduce the risks such as mental nerve injury and tears at the corners of the mouth and meanwhile avoid the possible interference between the instruments. So, it has certain clinical application value.