三孔无气经肌间入路内镜甲状腺切除术：六步法

文献信息

中文摘要

背景： 全球甲状腺癌发病率呈上升趋势。经锁骨下入路的内镜甲状腺手术可保留颈前功能，患者术后无颈前皮肤麻木、颈部肌肉紧绷感或吞咽时异物感。由于切口位置相对隐蔽，其美容效果也更优，因而逐渐成为传统开放手术的有力补充。然而，该技术在切口大小、皮瓣游离范围及手术器械操作方面存在一定局限。本研究提出一种三孔无气经肌间入路内镜甲状腺切除术，旨在进一步提高术者操作舒适度、减少患者锁骨下切口创伤并提高美容满意度。
方法： 回顾性分析2024年6月至9月期间接受单侧甲状腺腺叶切除术的91例患者的临床资料。其中41例患者接受三孔无气经肌间入路内镜手术（TGI组），50例患者接受传统开放手术（OP组）。本研究详细描述了标准化的六步手术技术，总结了术中注意事项，并比较了TGI组与OP组的临床结局。
结果： 两组在性别、年龄、体重指数、住院时间及暂时性喉返神经损伤方面差异均无统计学意义（均P > 0.05）。与OP组相比，TGI组总引流量显著更低（83.5 ± 18.2 mL vs. 93.2 ± 25.3 mL），术后6个月美容满意度评分更高[5.0（5.0，5.0）vs. 4.0（3.0，4.0）]（P < 0.05）。TGI组还显示出手术时间更短的趋势[47.0（45.0，51.0）min vs. 50.0（45.0，67.3）min，P = 0.064]。
结论： 三孔无气经肌间入路内镜手术进一步缩短了传统锁骨下手术的切口长度，减小了皮瓣游离范围，减少了软组织创伤，并改善了美容效果。该入路还优化了器械操作平面，进一步减少了器械之间的“筷子效应”，从而提高了术者操作舒适度。

英文摘要

BACKGROUND: The global incidence of thyroid cancer is on the rise. Endoscopic thyroid surgery via an infraclavicular approach preserves anterior cervical function, with patients experiencing no postoperative numbness of the anterior cervical skin, neck muscle tightness, or foreign body sensation during swallowing. It also offers superior cosmetic outcomes due to the relatively concealed incision site, thereby gradually becoming a strong complement to conventional open surgery. However, this technique presents certain limitations in terms of incision size, extent of flap dissection, and surgical instrument manipulation. The present study proposes a three-port gasless intermuscular approach for endoscopic thyroidectomy, aiming to further enhance operating surgeon comfort, reduce infraclavicular incision trauma in patients, and improve cosmetic satisfaction.
METHODS: The clinical data of 91 patients who underwent unilateral thyroid lobectomy between June and September 2024 were retrospectively analyzed. Among them, 41 patients underwent endoscopic surgery via a three-port gasless intermuscular approach (TGI group), and 50 patients were treated via conventional open surgery (OP group). The study provides a detailed description of the standardized six-step surgical technique, summarizes intraoperative precautions, and compares the clinical outcomes between the TGI and OP groups.
RESULTS: There were no statistically significant differences between the two groups in terms of sex, age, body mass index, hospital length of stay, and temporary recurrent laryngeal nerve injury (all P > 0.05). The TGI group had a significantly lower total drainage volume (83.5 ± 18.2 mL vs. 93.2 ± 25.3 mL) and a higher cosmetic satisfaction score [5.0 (5.0, 5.0) vs. 4.0 (3.0, 4.0)] at 6 months postoperatively compared to those in the OP group (P < 0.05). The TGI group also showed a trend toward shorter operative time [47.0 (45.0, 51.0) min vs. 50.0 (45.0, 67.3) min, P = 0.064].
CONCLUSIONS: The three-port gasless intermuscular approach for endoscopic surgery further shortens the incision length of conventional infraclavicular surgery, reduces the extent of flap dissection, decreases soft tissue trauma, and improves cosmetic outcomes. It also optimizes the instrument operating plane to further reduce the "chopstick effect" between instruments, thereby enhancing operating surgeon comfort.