经口腔前庭入路腔镜甲状腺手术并发症预防及处理：单中心1 941例及文献报道152例多中心数据分析

背景与目的 经口腔前庭入路腔镜甲状腺手术（TOETVA）不仅可彻底切除病灶，而且术后完全无痕。但是此技术具有一定难度，手术并发症的出现不可避免。本研究以笔者所在中心临床数据为主，结合其他中心报道的数据，探讨此手术并发症预防及处理的经验。方法 回顾性分析笔者中心2016年3月—2022年10月期间2 710例甲状腺肿瘤患者行手术治疗的临床资料。其中1 941例行TOETVA，49例行经颏下联合经口腔镜甲状腺手术（TOaST），110例行机器人辅助下经口甲状腺手术（TORT），610例行传统颈部皮肤切开甲状腺手术（TCA），分析各种甲状腺手术并发症的发生情况及处理，以及一项联合5家独立医疗机构关于TOETVA手术并发症的临床研究的数据。结果 笔者中心数据显示，TOETVA组出现皮肤损伤16例（0.82%）、气管损伤2例（0.1%）、暂时性喉返神经损伤38例（1.96%），术后感染5例（0.26%），永久性甲状旁腺功能减退1例（0.05%）；TOETVA组各项主要手术并发症发生率与其他术式组差异均无统计学意义（均P>0.05）；所有并发症均经适当的处理后缓解或自行痊愈。联合5家独立医疗机构的152例TOETVA手术并发症统计显示，皮肤损伤9例（5.9%），气管破损3例（1.3%），暂时性喉返神经损伤5例（4.7%），术后感染1例（0.7%）。结论 TOETVA除了自身的优势外，并无增加的并发症发生率。笔者中心TOETVA手术并发症发生率低于文献报道，这提示手术例数的增多与经验的积累是减少TOETVA手术并发症手术质量的关键。

Complications of transoral endoscopic thyroidectomy vestibular approach and the management: analysis of a single-center series of 1 941 cases and multi-center data of 152 cases reported by literature

Background and Aims Transoral endoscopic thyroidectomy vestibular approach (TOETVA) can not only thoroughly remove the lesion but also be utterly traceless after operation. However, there are some difficulties in carrying out this technique, and surgical complications are inevitable. This study was conducted to summarize the experience in prevention and treatment of the complications of this procedure by analyzing the clinical data from the authors'' center combined with the data from other centers.Methods The clinical data of 2 710 patients with thyroid tumors undergoing surgical treatment in the authors'' center from March 2016 to October 2022 were analyzed retrospectively. Of the patients, 1 941 cases underwent TOETVA, 49 cases underwent transoral and submental endoscopic thyroidectomy (TOaST), 110 cases underwent transoral robotic thyroidectomy (TORT), and 610 cases underwent thyroidectomy via conventional transcervical approach (TCA). The incidence rates of surgical complications of each procedure and their treatment, as well as the clinical data concerning surgical complications of TOETVA from a study across 5 independent medical institutions, were analyzed.Results The data of the authors'' center showed that skin injury occurred in 16 cases (0.82%), trachea injury occurred in 2 cases (0.1%), temporary recurrent laryngeal nerve injury occurred in 38 cases (1.96%), postoperative infection occurred in 5 cases (0.26%), and permanent hypoparathyroidism occurred in 1 case (0.05%) in TOETVA group; In the traditional cervical skin thyroidectomy group, there was 1 case (2.29%) of trachea injury, 14 cases (2.29%) of temporary recurrent laryngeal nerve injury, and 3 cases (0.49%) of postoperative infection; there were no significant differences in the main surgical complications in TOETVA group compared with other procedure groups (all P>0.05); all complications were resolved after appropriate treatments or spontaneously. The statistics of surgical complications in 152 TOETVA cases from the other 5 independent medical institutions showed that there were 9 cases (5.9%) of skin injury, 3 cases (1.3%) of trachea injury, 5 cases (4.7%) of temporary recurrent laryngeal nerve injury, and 1 case (0.7%) of postoperative infection.Conclusion In addition to its advantages, TOETVA will not increase the incidence of complications. The lower incidence rate of complications after TOETVA in the authors'' center than that in literature reports suggests that the increase in operation cases and accumulation of surgical experience are the keys to reducing the surgical complications of TOETVA and improving the surgical quality.