经锁骨下入路无充气腔镜甲状腺切除术：安全性与颈前功能保护更优
Gasless endoscopic thyroidectomy via the transsubclavian approach: comparable safety and superior anterior cervical function preservation.
文献信息
| PMID | 42867642 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Chengmin Huang |
| 作者单位 | Department of Surgery, Changxing People's Hospital, 66 Taihu Road, Changxing, 313100, Huzhou, China. |
| 期刊 | European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery |
| SCI 分区 | Q1 |
| IF | 2.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 针对甲状腺乳头状癌（PTC）的传统开放甲状腺切除术（COT）常导致颈前功能障碍和明显瘢痕。经锁骨下入路无充气腔镜甲状腺切除术（GETTSA）操作相对简便且美容效果更佳。本研究评估GETTSA与COT相比是否能提供足够的切除完整性和有效性，同时更好地保护颈前功能。
方法： 本前瞻性队列研究连续纳入2023年至2025年间接受单侧甲状腺腺叶切除术的单侧PTC患者，GETTSA组37例，COT组65例。前瞻性收集基线和围手术期数据。在术后1、3和6个月使用温哥华瘢痕量表（VSS）、颈部损伤评分（NIS）、吞咽损伤评分（SIS）和嗓音损伤评分（VIS）评估瘢痕外观和颈前功能。组间比较采用t检验、Mann-Whitney U检验或卡方检验，并使用广义估计方程（GEE）评估纵向的组别、时间及交互效应。
结果： 两组基线特征具有可比性。GETTSA组手术时间更长（P<0.001），但术中出血更少（P=0.002）；住院时间略长（P<0.001）。GETTSA组甲状旁腺自体移植率更高（P<0.001），但术后PTH和钙水平相似。GEE显示VSS、NIS和SIS存在显著的组别和时间效应（均P<0.001），且组别-时间交互作用显著（分别为P=0.048、P=0.026和P<0.001），表明GETTSA组恢复更好、更快。VIS显示显著的时间效应（P<0.001），但无组别效应（P=0.333）或交互作用（P=0.637）。所有患者均实现R0切除，未发生重大手术相关并发症。
结论： GETTSA提供更优的功能和美容结局——尤其是吞咽功能改善、瘢痕外观更好以及颈部不适减轻——同时术中出血更少、甲状旁腺安全性相当且切除完整性足够。长期肿瘤学监测正在进行中。
英文摘要
BACKGROUND: Conventional open thyroidectomy (COT) for papillary thyroid carcinoma (PTC) frequently induces anterior cervical dysfunction and conspicuous scarring. The gasless endoscopic thyroidectomy via the transsubclavian approach (GETTSA) offers technical simplicity and superior cosmesis. This study assessed whether GETTSA provides adequate completeness of resection and effectiveness compared with COT while achieving superior preservation of anterior cervical function.
METHODS: This prospective cohort study enrolled consecutive patients with unilateral PTC who underwent hemithyroidectomy between 2023 and 2025, with 37 in the GETTSA group and 65 in the COT group. Baseline and perioperative data were prospectively collected. Scar appearance and anterior cervical function were assessed using the Vancouver Scar Scale (VSS), Neck Impairment Score (NIS), Swallowing Impairment Score (SIS), and Voice Impairment Score (VIS) at 1, 3, and 6 months. Group comparisons were performed using t‑tests, Mann-Whitney U tests, or chi‑square tests, and generalized estimating equations (GEE) evaluated longitudinal group, time, and interaction effects.
RESULTS: Baseline characteristics between the two groups were comparable. GETTSA had a longer operative time (P < 0.001) but less intraoperative blood loss (P = 0.002); hospital stay was slightly longer (P < 0.001). Parathyroid autotransplantation rates were higher in GETTSA (P < 0.001), yet postoperative PTH and calcium levels were similar. GEE demonstrated significant group and time effects for VSS, NIS, and SIS (all P < 0.001), with significant group‑by‑time interactions (P = 0.048, P = 0.026, and P < 0.001, respectively), indicating better and faster recovery in the GETTSA group. VIS showed a significant time effect (P < 0.001), but no group effect (P = 0.333) or interaction (P = 0.637). R0 resection was achieved in all patients, and no major procedure‑related complications occurred.
CONCLUSION: GETTSA offers superior functional and cosmetic outcomes-notably improved swallowing function, better scar appearance, and reduced neck discomfort-with less intraoperative bleeding, comparable parathyroid safety, and adequate completeness of resection. Long‑term oncological surveillance is ongoing.