男性性别是经口腔内镜甲状腺切除术的障碍吗？手术结局的比较研究。

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中文摘要

目的： 经口腔前庭入路内镜甲状腺切除术（TOETVA）因男性患者的解剖特征而在技术上具有挑战性。然而，性别对TOETVA术后临床结局的影响仍不明确。
方法： 这项回顾性研究分析了2019年至2023年间接受TOETVA的男性和女性患者的基线特征及临床病理结局。采用多变量logistic回归分析检验与手术时间延长（高于第75百分位数）相关的因素。
结果： 在131例经口腔入路接受单侧腺叶切除术的患者中，20例（15.3%）为男性。与女性相比，男性患者的引流量显著更高（75.7 mL vs. 59.3 mL，P = 0.045），术后住院时间更短（2.5天 vs. 2.8天，P = 0.016）。持续时间>1周的瘀斑在男性中也更常见（20.0% vs. 5.4%，P = 0.044），并且1例男性患者（5.0%，1/20）在建立操作空间时发生颏瓣穿孔。其他围手术期结局，包括手术时间、失血量、甲状腺重量和疼痛评分，在男女之间相当。声带麻痹和意外甲状旁腺切除术的发生率也相似。值得注意的是，logistic回归分析显示，甲状腺重量是手术时间延长的唯一独立预测因素（比值比，1.11；95%置信区间，1.03-1.21；P = 0.008），而性别与之无关。
结论： TOETVA在男性患者中是可行的，其结局总体上与女性相当。外科医生在男性患者手术时应谨慎操作，以尽量减少软组织创伤。甲状腺重量而非性别是手术持续时间的主要决定因素。

英文摘要

PURPOSE: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) presents technical challenges in male patients because of their anatomical characteristics. However, the impact of sex on clinical outcomes following TOETVA remains unclear.
METHODS: This retrospective study analyzed the baseline characteristics and clinicopathological outcomes of male and female patients who underwent TOETVA between 2019 and 2023. Factors associated with prolonged operative time (above the 75th percentile) were examined using a multivariable logistic regression analysis.
RESULTS: Of 131 patients who underwent unilateral lobectomy via the transoral approach, 20 (15.3%) were male. Male patients had significantly higher drainage volumes (75.7 mL vs. 59.3 mL, P = 0.045) and shorter postoperative stays (2.5 days vs. 2.8 days, P = 0.016) compared to females. Ecchymosis lasting >1 week was also more frequent in males (20.0% vs. 5.4%, P = 0.044), and 1 male patient (5.0%, 1/20) experienced chin flap perforation during workspace creation. Other perioperative outcomes, including operative time, blood loss, thyroid gland weight, and pain scores, were comparable between sexes. The rates of vocal cord palsy and incidental parathyroidectomy were also similar. Notably, logistic regression analysis revealed that thyroid gland weight was the sole independent predictor of prolonged operative time (odds ratio, 1.11; 95% confidence interval, 1.03-1.21; P = 0.008), while sex was not associated.
CONCLUSION: TOETVA is feasible in male patients with outcomes generally comparable to females. Surgeons should exercise caution when operating on male patients to minimize soft tissue trauma. Thyroid weight, rather than sex, is the main determinant of operative duration.