无充气腋窝入路腔镜甲状腺切除术的安全性、短期患者报告结局及美容满意度：530例患者的回顾性分析

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中文摘要

背景： 无充气腋窝入路腔镜甲状腺切除术（GTET）可消除颈部可见瘢痕，已越来越多地用于单侧甲状腺疾病的管理。本研究旨在评估其安全性、可行性、围手术期并发症、术式特异性不适及美容满意度。
方法： 我们回顾性分析了2023年1月至2026年2月期间连续接受GTET的530例单侧甲状腺疾病患者。为评估手术经验，将406例甲状腺乳头状癌（PTC）患者按时间顺序分为早期组和晚期组（每组203例）。多变量线性回归对基线混杂因素进行了校正。术后36小时测定血清PTH和钙。术后1周和3个月采用改良言语评定量表（VRS，0-3）评估胸壁感觉异常和胸锁乳突肌（SCM）不适，并通过患者满意度评分（PSS，0-3）评估美容满意度。
结果： 在530例患者中（406例PTC，124例良性），4例（0.75%）需中转开放手术（2例因颈内静脉出血，2例因术中喉返神经离断并即刻行神经吻合术；均未发生永久性麻痹）。术后血肿发生于6例患者（1.13%；1例再次手术，5例保守治疗）。2例气管损伤和1例食管损伤经内镜下修复，均在2个月内恢复。暂时性声带麻痹发生于34例患者（6.42%），永久性3例（0.57%），暂时性甲状旁腺功能减退11例（2.08%）。多变量回归证实，晚期阶段独立预测更短的手术时间（β = -14.2分钟，P < 0.001）和更高的术后PTH（β = 4.8 pg/mL，P < 0.001）。胸壁感觉异常和SCM不适从1周到3个月显著改善（VRS：1.41 ± 0.53 vs. 0.36 ± 0.42和1.84 ± 0.55 vs. 0.43 ± 0.53，P < 0.001）。在中位随访25.3个月（IQR：9.2-34.6）期间，未发生原发部位复发。6例患者（1.13%）在对侧叶发生异时性微小PTC（0.1-0.4 cm），均通过补充甲状腺切除术成功治疗。
结论： GTET对于经过仔细筛选的单侧甲状腺疾病患者是一种安全可行的选择，具有良好的美容满意度和可接受的并发症发生率。术式相关症状是暂时性的。手术经验的积累可独立提高手术效率和甲状旁腺保护。

英文摘要

BACKGROUND: Gasless transaxillary endoscopic thyroidectomy (GTET) eliminates visible cervical scarring and has been increasingly adopted for managing unilateral thyroid diseases. This study aimed to evaluate its safety, feasibility, perioperative complications, procedure-specific discomfort, and cosmetic satisfaction.
METHODS: We retrospectively reviewed 530 consecutive patients with unilateral thyroid disease who underwent GTET between January 2023 and February 2026. To evaluate surgical experience, 406 patients with papillary thyroid carcinoma (PTC) were chronologically divided into early- and late-phase groups (203 cases each). Multivariable linear regression adjusted for baseline confounders. Serum PTH and calcium were measured at 36 hours. Chest wall sensory disturbance and sternocleidomastoid (SCM) discomfort were evaluated at 1 week and 3 months using a modified Verbal Rating Scale (VRS, 0-3), and cosmetic satisfaction via Patient Satisfaction Score (PSS, 0-3).
RESULTS: Among 530 patients (406 PTC, 124 benign), four (0.75%) required conversion to open surgery (two for internal jugular vein bleeding, two for intraoperative recurrent laryngeal nerve transection with immediate neurorrhaphy; none developed permanent paralysis). Postoperative hematoma occurred in six patients (1.13%; one reoperated, five managed conservatively). Two tracheal and one esophageal injury were repaired endoscopically, all recovering within 2 months. Transient vocal cord paralysis occurred in 34 patients (6.42%), permanent in three (0.57%), and transient hypoparathyroidism in 11 (2.08%). Multivariable regression confirmed the late phase independently predicted shorter operative time (β = -14.2 min, P < 0.001) and higher postoperative PTH (β = 4.8 pg/mL, P < 0.001). Chest wall disturbance and SCM discomfort improved significantly from 1 week to 3 months (VRS: 1.41 ± 0.53 vs. 0.36 ± 0.42 and 1.84 ± 0.55 vs. 0.43 ± 0.53, P < 0.001). Over a median follow-up of 25.3 months (IQR: 9.2-34.6), no primary site recurrences occurred. Six patients (1.13%) developed metachronous micro-PTC (0.1-0.4 cm) in the contralateral lobe, successfully treated with completion thyroidectomy.
CONCLUSIONS: GTET is a safe and feasible option for carefully selected patients with unilateral thyroid disease, offering favorable cosmetic satisfaction and acceptable morbidity. Procedure-related symptoms are transient. Accumulating surgical experience independently improves operational efficiency and parathyroid preservation.