目的探讨经口腔前庭入路腔镜甲状腺切除术(endoscopic thyroidectomy using the oral vestibular approach,ETOVA)与传统颈部开放手术治疗女性甲状腺乳头状癌的安全性、有效性及美容效果。方法回顾性分析2019年1~12月行甲状腺乳头状癌...目的探讨经口腔前庭入路腔镜甲状腺切除术(endoscopic thyroidectomy using the oral vestibular approach,ETOVA)与传统颈部开放手术治疗女性甲状腺乳头状癌的安全性、有效性及美容效果。方法回顾性分析2019年1~12月行甲状腺乳头状癌根治术的120例女性患者的临床资料,分为经口腔前庭入路腔镜甲状腺手术组(腔镜组,n=60)和传统颈部开放手术组(开放组,n=60),对比两组患者术中及术后相关临床资料。结果两组患者年龄、肿瘤直径、中央区淋巴结清扫时间、中央区淋巴结清扫总数、中央区转移淋巴结数量、术后并发症、术后24 h疼痛评分、术后6个月疼痛评分均无统计学差异(P均>0.05)腔镜组手术总时长、术中失血量、术后引流量均大于开放组(P均<0.001),腔镜组术后满意度高。结论ETOVA在治疗甲状腺乳头状癌是安全、有效的,具有更好的美容效果,患者满意度高,可以考虑作为部分患者,尤其是年轻女性甲状腺乳头状癌患者的首选手术方案。展开更多
Background:Transoral vestibular approach thyroidectomy using robotic system has advantages with articulating instrumentation.Transoral robotic thyroidectomy(TORT)can be done either using just two robot arms for instru...Background:Transoral vestibular approach thyroidectomy using robotic system has advantages with articulating instrumentation.Transoral robotic thyroidectomy(TORT)can be done either using just two robot arms for instruments and an extra one for the endoscopic camera,or using three robot arms for instruments(third arm through axila)and an additional arm for the camera.Pros of additional axillary arm for TORT:The 4th arm through an additional axillary port is mainly responsible for a counter-traction of strap muscles and thyroid tissue.The additional axillary port tract is also an excellent passage for the specimen removal with lower risk of disruption or fragmentation.Ultimately,these merits from the additional axillary arm allows TORT to be performed safely in a wide range of patient groups.Cons of additional axillary arm for TORT:One of the issue with the additional axillary arm in TORT is that it leaves a cutaneous scar.Another issue to consider is the cost.In some places,robotic surgery operation fee varies with the number of arms used during the operation.Retraction of strap muscles through subcutaneous stitches applied after establishing the working space may make up for the lack of counter-traction.Conclusion:TORT can be done safely with or without the transaxillary arm and surgeon may consider pros and cons based on multiple factors.展开更多
Background:Total removal of the vestibular schwannoma when preserving the function of the facial nerve is difficult.The objective of the current study was to investigate the short-term clinical outcome of vestibular s...Background:Total removal of the vestibular schwannoma when preserving the function of the facial nerve is difficult.The objective of the current study was to investigate the short-term clinical outcome of vestibular schwannoma removal via retro-sigmoid approach.Methods:One-hundred consecutive patients diagnosed with vestibular schwannoma were surgically treated between December 2018 and August 2019 in Xuanwu Hospital,Capital Medical University.The clinical classification,surgical position,gross total removal rate,the anatomical and functional preservation rates of facial nerve,and the postoperative complications were retrospectively analyzed.Results:All 100 patients including 34 males and 66 females were operated on via retro-sigmoid approach.According to Koos vestibular schwannoma grading system,18 cases were grade 2,34 cases were grade 3,and 48 cases were grade 4.According to Hannover vestibular schwannoma grading system,5 cases were T2,6 cases were T3a,8 cases were T3b,30 cases were T4a,and 51 cases were T4b.Seventy-three surgeries were performed under lateral position,and 27 cases were operated under semi-sitting position.The gross total removal rate was 90.0%;the anatomic reservation rate of the facial nerve was 96.0%.According to the House-Brackman system,the facial nerve function was grades 1-2 in 78.0%cases,grade 3 in 7.0%cases,and grades 4-5 in 15%cases.For patients with effective hearing before operation,the hearing reservation rate was 19.0%.Two patients(2.0%)developed intracranial hematoma after operation.Conclusion:Most vestibular schwannoma could be completely removed with good postoperative facial nerve function.If total removal of tumor is difficult,we should give priority to the functional preservation of the nerve function.展开更多
背景与目的:目前,机器人甲状腺手术中采用吲哚菁绿(ICG)荧光显影技术识别与保护甲状旁腺的相关报道相对较少,因此,其临床实用性仍需进一步研究。本研究通过比较在经口腔前庭入路机器人甲状腺切除术(TORTVA)使用与不使用ICG荧光显影技术...背景与目的:目前,机器人甲状腺手术中采用吲哚菁绿(ICG)荧光显影技术识别与保护甲状旁腺的相关报道相对较少,因此,其临床实用性仍需进一步研究。本研究通过比较在经口腔前庭入路机器人甲状腺切除术(TORTVA)使用与不使用ICG荧光显影技术病例资料的对比分析,探讨TORTVA术中应用ICG荧光显影技术的安全性与有效性。方法:回顾性收集2018年12月—2021年11月行TORTVA患者的病历资料,经筛选后纳入80例患者,其中45例术中采用ICG荧光显影技术(ICG组),35例未使用ICG荧光显影技术(对照组),采用1∶1最邻近匹配法进行倾向性评分匹配(PSM)消除两组间混淆偏差后,比较两组患者术中、术后相关指标。结果:PSM后,两组各纳入24例患者,两组间基线资料均衡可比。ICG组与对照组的术中出血量差异无统计学意义(P=0.910),但ICG组的平均手术时间明显短于对照组(223 min vs.251 min,P=0.032)。两组术中淋巴结清扫数目、阳性淋巴结数目及淋巴结阳性率差异均无统计学意义(均P>0.05)。两组患者总住院时间与术后住院时间差异无统计学意义(均P>0.05)。两组间术后甲状旁腺素与血清钙水平差异均无统计学意义(均P>0.05)。ICG组3例(12.5%)、对照组6例(25.0%)出现并发症,两组间并发症发生率的差异无统计学意义(P=0.461);两组均无术中甲状旁腺自体移植患者,均无永久性喉返神经损伤和甲状旁腺功能减退发生。结论:TORTVA术中利用ICG荧光显影技术不会增加术后并发症的风险,具有可靠的安全性;TORTVA术中利用ICG荧光显影技术可以更清楚地显示甲状旁腺,显著缩短手术时间,具有一定的有效性。展开更多
Advances in imaging for preoperative localization have propelled the widespread adoption of minimally invasive/focused parathyroidectomy in primary hyperparathyroidism.Though it is performed through a relatively small...Advances in imaging for preoperative localization have propelled the widespread adoption of minimally invasive/focused parathyroidectomy in primary hyperparathyroidism.Though it is performed through a relatively small incision,studies have shown that the presence of a neck scar increases attentional bias towards the neck resulting in compromised quality of life.Transoral endoscopic parathyroidectomy vestibular approach(TOEPVA)eliminates a neck scar.While indications for TOEPVA are the same as that of minimally invasive open parathyroidectomy,confident preoperative localization of the parathyroid with a surgeon performed ultrasound along with concordant localization with SPECT CT is an essential prerequisite before offering patients this approach for parathyroidectomy.Early data has demonstrated the feasibility and safety of this approach.展开更多
文摘目的探讨经口腔前庭入路腔镜甲状腺切除术(endoscopic thyroidectomy using the oral vestibular approach,ETOVA)与传统颈部开放手术治疗女性甲状腺乳头状癌的安全性、有效性及美容效果。方法回顾性分析2019年1~12月行甲状腺乳头状癌根治术的120例女性患者的临床资料,分为经口腔前庭入路腔镜甲状腺手术组(腔镜组,n=60)和传统颈部开放手术组(开放组,n=60),对比两组患者术中及术后相关临床资料。结果两组患者年龄、肿瘤直径、中央区淋巴结清扫时间、中央区淋巴结清扫总数、中央区转移淋巴结数量、术后并发症、术后24 h疼痛评分、术后6个月疼痛评分均无统计学差异(P均>0.05)腔镜组手术总时长、术中失血量、术后引流量均大于开放组(P均<0.001),腔镜组术后满意度高。结论ETOVA在治疗甲状腺乳头状癌是安全、有效的,具有更好的美容效果,患者满意度高,可以考虑作为部分患者,尤其是年轻女性甲状腺乳头状癌患者的首选手术方案。
文摘Background:Transoral vestibular approach thyroidectomy using robotic system has advantages with articulating instrumentation.Transoral robotic thyroidectomy(TORT)can be done either using just two robot arms for instruments and an extra one for the endoscopic camera,or using three robot arms for instruments(third arm through axila)and an additional arm for the camera.Pros of additional axillary arm for TORT:The 4th arm through an additional axillary port is mainly responsible for a counter-traction of strap muscles and thyroid tissue.The additional axillary port tract is also an excellent passage for the specimen removal with lower risk of disruption or fragmentation.Ultimately,these merits from the additional axillary arm allows TORT to be performed safely in a wide range of patient groups.Cons of additional axillary arm for TORT:One of the issue with the additional axillary arm in TORT is that it leaves a cutaneous scar.Another issue to consider is the cost.In some places,robotic surgery operation fee varies with the number of arms used during the operation.Retraction of strap muscles through subcutaneous stitches applied after establishing the working space may make up for the lack of counter-traction.Conclusion:TORT can be done safely with or without the transaxillary arm and surgeon may consider pros and cons based on multiple factors.
基金supported by National Key R&D Program of China(2021YFC2400803)
文摘Background:Total removal of the vestibular schwannoma when preserving the function of the facial nerve is difficult.The objective of the current study was to investigate the short-term clinical outcome of vestibular schwannoma removal via retro-sigmoid approach.Methods:One-hundred consecutive patients diagnosed with vestibular schwannoma were surgically treated between December 2018 and August 2019 in Xuanwu Hospital,Capital Medical University.The clinical classification,surgical position,gross total removal rate,the anatomical and functional preservation rates of facial nerve,and the postoperative complications were retrospectively analyzed.Results:All 100 patients including 34 males and 66 females were operated on via retro-sigmoid approach.According to Koos vestibular schwannoma grading system,18 cases were grade 2,34 cases were grade 3,and 48 cases were grade 4.According to Hannover vestibular schwannoma grading system,5 cases were T2,6 cases were T3a,8 cases were T3b,30 cases were T4a,and 51 cases were T4b.Seventy-three surgeries were performed under lateral position,and 27 cases were operated under semi-sitting position.The gross total removal rate was 90.0%;the anatomic reservation rate of the facial nerve was 96.0%.According to the House-Brackman system,the facial nerve function was grades 1-2 in 78.0%cases,grade 3 in 7.0%cases,and grades 4-5 in 15%cases.For patients with effective hearing before operation,the hearing reservation rate was 19.0%.Two patients(2.0%)developed intracranial hematoma after operation.Conclusion:Most vestibular schwannoma could be completely removed with good postoperative facial nerve function.If total removal of tumor is difficult,we should give priority to the functional preservation of the nerve function.
文摘背景与目的:目前,机器人甲状腺手术中采用吲哚菁绿(ICG)荧光显影技术识别与保护甲状旁腺的相关报道相对较少,因此,其临床实用性仍需进一步研究。本研究通过比较在经口腔前庭入路机器人甲状腺切除术(TORTVA)使用与不使用ICG荧光显影技术病例资料的对比分析,探讨TORTVA术中应用ICG荧光显影技术的安全性与有效性。方法:回顾性收集2018年12月—2021年11月行TORTVA患者的病历资料,经筛选后纳入80例患者,其中45例术中采用ICG荧光显影技术(ICG组),35例未使用ICG荧光显影技术(对照组),采用1∶1最邻近匹配法进行倾向性评分匹配(PSM)消除两组间混淆偏差后,比较两组患者术中、术后相关指标。结果:PSM后,两组各纳入24例患者,两组间基线资料均衡可比。ICG组与对照组的术中出血量差异无统计学意义(P=0.910),但ICG组的平均手术时间明显短于对照组(223 min vs.251 min,P=0.032)。两组术中淋巴结清扫数目、阳性淋巴结数目及淋巴结阳性率差异均无统计学意义(均P>0.05)。两组患者总住院时间与术后住院时间差异无统计学意义(均P>0.05)。两组间术后甲状旁腺素与血清钙水平差异均无统计学意义(均P>0.05)。ICG组3例(12.5%)、对照组6例(25.0%)出现并发症,两组间并发症发生率的差异无统计学意义(P=0.461);两组均无术中甲状旁腺自体移植患者,均无永久性喉返神经损伤和甲状旁腺功能减退发生。结论:TORTVA术中利用ICG荧光显影技术不会增加术后并发症的风险,具有可靠的安全性;TORTVA术中利用ICG荧光显影技术可以更清楚地显示甲状旁腺,显著缩短手术时间,具有一定的有效性。
文摘Advances in imaging for preoperative localization have propelled the widespread adoption of minimally invasive/focused parathyroidectomy in primary hyperparathyroidism.Though it is performed through a relatively small incision,studies have shown that the presence of a neck scar increases attentional bias towards the neck resulting in compromised quality of life.Transoral endoscopic parathyroidectomy vestibular approach(TOEPVA)eliminates a neck scar.While indications for TOEPVA are the same as that of minimally invasive open parathyroidectomy,confident preoperative localization of the parathyroid with a surgeon performed ultrasound along with concordant localization with SPECT CT is an essential prerequisite before offering patients this approach for parathyroidectomy.Early data has demonstrated the feasibility and safety of this approach.
