达芬奇机器人甲状腺手术650例

详细信息    查看全文 | 推荐本文 |

英文篇名：Experience of 650 cases of thyroid surgery by da Vinci robot 作者：王猛 ; 郑鲁明 ; 贺青卿 ; 朱见 ; 周鹏 ; 王刚 ; 于芳 ; 岳涛 ; 庄大勇 ; 范子义 ; 王丹 ; 李小磊 ; 李丹丹 英文作者：WANG Meng;ZHENG Luming;HE Qingqing;ZHU Jian;ZHOU Peng;WANG Gang;YU Fang;YUE Tao;ZHUANG Dayong;FAN Ziyi;WANG Dan;LI Xiaolei;LI Dandan;Departmeng of Thyroid and Breast Surgery, the 960th Hospital of PLA; 关键词：甲状腺肿瘤 ; 外科手术 ; 达芬奇机器人 ; BABA径路 英文关键词：Thyroid Neoplasms;;Surgical Procedures,Operative;;da Vinci robot;;BABA approach 中文刊名：EBYT 英文刊名：Chinese Archives of Otolaryngology-Head and Neck Surgery 机构：解放军第九六○医院甲状腺乳腺外科; 出版日期：2019-03-28 出版单位：中国耳鼻咽喉头颈外科 年：2019 期：v.26 基金：博士后科学基金第三批特别资助项目(201003759);; 原济南军区总医院院长基金资助项目(2011M03、2013ZD05、2016ZD02)联合资助 语种：中文; 页：EBYT201903001 页数：5 CN：03 ISSN：11-5175/R 分类号：6-10

摘要

目的探讨达芬奇机器人在甲状腺手术中的安全性、可靠性及美容效果。方法回顾性分析2014年2月～2018年4月解放军第九六○医院(原济南军区总医院)行机器人甲状腺手术650例患者的临床资料,并根据病理结果分为良性组和恶性组,分别统计两组肿瘤直径、淋巴结转移例数(恶性)、美容效果满意度,喉返神经损伤及甲状旁腺功能减退等。结果两组手术均顺利完成,无中转开放。两组均无永久性甲状旁腺功能减退,恶性组有1例永久性喉返神经损伤。①良性组共199例:手术平均时间为(97.87±14.02)分钟,术后平均引流液体量为(146.65±81.74)ml,术后平均住院时间为(5.76±1.75)天,暂时性喉返神经损伤2例,暂时性甲状旁腺功能减退19例。②恶性组共451例:Ⅵ、Ⅲ、Ⅳ组淋巴结转移率分别为46.56%(210/451)、41.17%(105/255)、29.41%(75/255);手术平均时间为(144.56±44.81)分钟,术后平均引流液体量为(231.21±90.04)ml,暂时性喉返神经损伤5例,暂时性甲状旁腺功能减退101例。结论达芬奇机器人甲状腺手术安全有效可靠,具有较好的美容效果。
        OBJECTIVE To explore the treatment and cosmetic effect of da Vinci robot in thyroid surgery.METHODS The clinical data of 650 cases of robot thyroid surgery in the 960 th Hospital of PLA(the formerly General Hospital of Jinan Military region) from February 2014 to April 2018 were analyzed retrospectively, and the pathological results were divided into benign group and malignant group respectively. The tumor diameter, lymph node metastasis cases(malignant), average time of operation, postoperative average drainage volume, average hospitalization time after operation, satisfaction of cosmetic effect, injury of recurrent laryngeal nerve and decrease of parathyroid function were recorded. RESULTS Both groups were successfully completed without open surgery. Both groups had no permanent hypoparathyroidism and one case of permanent laryngeal recurrent nerve injury in malignant group. 1. Benign group had 199 cases: the average time of operation was(97.87±14.02) min, the average amount of drainage after operation was(146.65±81.74) ml, average hospitalization time after operation was(5.76±1.75) d;temporary recurrent laryngeal nerve injury in 2 cases, temporary parathyroid function decreased in 19 cases. 2. Malignant group had 451 cases: the lymph node metastasis rate of Ⅵ, Ⅲ and Ⅳ level were 46.56%(210/451), 41.17%(105/255), 29.41%(75/255), the average time of operation was(144.56±44.81) min, the average drainage fluid volume after operation was(231.21±90.04) ml, temporary recurrent laryngeal nerve injury in 5 cases, temporary parathyroid function decreased in 101 cases. CONCLUSION The da vinci robot thyroid surgery is safe, effective and reliable, and has better cosmetic effect.

引文

[1]贺青卿,朱见,范子义,等·达芬奇机器人腋乳径路与传统开放手术治疗甲状腺微小癌的对照研究·中华外科杂志,2016,54(1):51-55.
    [2] Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patientswith Thyroid Nodules and Differentiated Thyroid Cancer:The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016, 26(1):1-133-
    [3] Bernard W, Christopher P. World Cancer Report 2014.International Agency for Research on Cancer, 2015, 1-953.
    [4]中国医师协会外科医师分会甲状腺外科医师委员会,中国研究型医院学会甲状腺疾病专业委员会·机器人手术系统辅助甲状腺和甲状旁腺手术专家共识·中国实用外科杂志,2016, 36(11):1165-1170.
    [5] Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract,2016, 22:1291-1300.
    [6]贺青卿·规范达芬奇机器人外科手术系统在甲状腺手术中的应用.中华外科杂志,2017, 55(8):570-573.
    [7]尹乐乐,范子义,于芳,等.达芬奇机器人甲状腺手术中甲状旁腺的损伤因素及保护.中华腔镜外科杂志(电子版),2016, 9(5):262-267.
    [8]王丹,朱见,周鹏,等.喉肌电活动实时监测在da Vinci机器人甲状腺手术中的应用·国际外科学杂志,2016, 43(2):115-117.
    [9]贺青卿,董学峰,于芳,等.甲状腺乳头状癌淋巴转移的特点及临床处理策略·中华内分泌外科杂志,2015, 9(1):1-3-
    [10] Zeng H, Chen W, Zheng R, et al. Changing cancer survival in China during 2003-15:a pooledanalysis of 17 population-based cancer registries. Lancet Global Health, 2018, 6(5), 555-567.
    [11] Siegel RL.Miller KD,Jemal A,Cancer Statistics,2017. CA Cancer J Clin,2017, 67(1):7-30.
    [12] Wang YC, Liu K, Xiong JJ, et al. Robotic thyroidectomy versus conventional open thyroidectomy for differentiated thyroid cancer:meta-analysis. J Laryngol Otol,2015, 129(6):558-567.
    [13] Hüscher CS, Chiodini S, Napolitano C, et al, Endoscopic right thyroid lobectomy. Surg Endosc, 1997, 11(8):877.
    [14] Kang SW, Jeong JJ,Yun JS,et al. Robot-assisted endoscopic surgery for thyroid cancer:experience with the first 100 patients.Surg Endosc,2009, 23(11):2399-2406.
    [15]贺青卿,李小磊,庄大勇·机器人甲状腺手术的发展现状和思考·中华内分泌外科杂志,2017, 11(5):356-358.
    [16]周鹏,庄大勇,贺青卿,等·FNAC联合FNA-Tg测定在分化型甲状腺癌患者术后随访中的临床应用·国际外科学杂志,2017, 44(12):829-832.
    [17]中国医师协会外科医师分会甲状腺外科医师委员会,中国研究型医院学会甲状腺疾病专业委员会,中国医学装备协会外科装备分会甲状腺外科装备委员会·超声引导下甲状腺结节细针穿刺活检专家共识及操作指南(2018版)·中国实用外科杂志,2018, 38(3):241-244.
    [18]贺青卿,于芳·达芬奇机器人甲状腺手术中甲状旁腺保护策略与技巧·中国普外基础与临床杂志,2017, 24(10):1180-1182-
    [19]朱见,贺青卿,庄大勇,等·双腋窝乳晕径路达芬奇机器人甲状腺癌手术并发症防治·国际外科学杂志,2017, 44(2):129-132-
    [20]王猛,郑鲁明,于芳,等·达芬奇机器人手术治疗甲状腺微小癌150例临床分析.中国实用外科杂志,2016, 36(5):540-546.
    [21]于芳,贺青卿·视觉思维在机器人甲状腺手术中功能保护的探索.医学与哲学,2018, 39(2):82-84.
    [22] Garas G, Arora A. Robotic Head and Neck Surgery:History,Technical Evolution and the Future. ORL J Otorhinolaryngol Relat Spec, 2018, 20(1):1-8.