Objectives: To compare the efficiacy of retro-auricular single-site endoscopic thyroidectomy (RASSET) and that of transoral endoscopic thyroidectomy vestibular approach (TOETVA). Methods: In Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, 10 patients underwent RASSET from June 2021 to August 2021, and 21 patients underwent TOETVA from January 2016 to August 2021. All the 21 patients' clinical data was analyzed retrospectively. There were 2 males and 8 females in the RASSET group, aging (48.2±13.9) years (range: 28 to 67 years). There were 5 males and 16 females in the TOETVA group, aging (31.3±8.2) years (range: 21 to 49 years). All patients underwent thyroid lobectomy. A 3 cm in length incision was cut on single auricula posterior sulci to creat the approach in the RASSET group. Then a Trocar made with of a glove was inserted. Retaining the omohyoid, the sternocleidomastoid muscle and anterior cervical muscle were pulled apart, exposing a single lobe of the thyroid gland and lymphatic tissue of zone Ⅵ, for en-bloc resection. The clinical data of the two groups were collected and analyzed by t test, Mann-Whitney U test, Fisher exact test or χ2 test. Clinical data and postoperative efficacy indexes such as operation time, postoperative C reactive protein level, and postoperative complications were recorded. Results: Compared with the TOETVA group, the operation time was longer in the RASSET group ((256.8±77.0) minutes vs. (201.2±54.9) minutes, t=2.31, P=0.028), and increase of postoperative C reaction protein (24 hours postoperative vs. preoperative) was lower in the RASSET group (8.58(13.24) mg/L vs. 46.24(48.88) mg/L, Z=-4.311, P<0.01). But there was no significant difference between the RASSET group and TOETVA group in the number of lymph nodes dissection (2(5) vs. 2(3), Z=-0.326, P=0.759). Besides, there were no complications in the RASSET group. Conclusion: Retro-auricular single-site endoscopic thyroid loectomy is easy to achieve the en-bloc resection of tumors with a well-concealed scar and less traumatic dissection.
目的： 比较经耳廓后沟入路和经口腔前庭入路单孔腔镜甲状腺手术的临床效果。 方法： 回顾性分析中山大学肿瘤防治中心头颈外科2021年6—8月开展的10例经耳廓后沟入路单孔腔镜甲状腺手术病例（耳后组）和2016年1月至2021年6月同中心开展的21例经口腔前庭入路腔镜甲状腺手术病例（口腔组）的资料。耳后组男性2例，女性8例，年龄（48.2±13.9）岁（范围：28~67岁）；口腔组男性5例，女性16例，年龄（31.3±8.2）岁（范围：21~49岁）。两组患者均接受单侧腺叶+峡部切除。耳后组通过耳后沟处长3 cm单孔切口建腔，置入“手套式”套管，保留肩胛舌骨肌，左右拉开胸锁乳突肌和颈前肌，暴露并连续完整切除甲状腺单侧腺叶及中央区淋巴结。采用t检验、Mann-Whitney U检验、χ2检验和Fisher确切概率法等比较两组患者的手术结果。 结果： 两组患者均顺利完成手术。耳后组的手术时间长于口腔组［（256.8±77.0）min比（201.2±54.9）min，t=2.31，P=0.028］，耳后组术后24 h C反应蛋白较术前增幅低于口腔组［8.58（13.24）mg/L比46.24（48.88）mg/L，Z=-4.311，P<0.01］。耳后组与口腔组淋巴结清扫数目无差异［2（5）枚比2（3）枚，Z=-0.326，P=0.759］。耳后组无并发症发生。 结论： 与经口腔前庭入路相比，经耳廓后沟单孔腔镜甲状腺单侧腺叶+峡部切除术将切口隐蔽至耳后，解剖量小，能达到肿瘤连续完整切除。.