经口腔前庭入路与经腋窝入路机器人辅助甲状腺癌根治术对颈部淋巴结清扫及喉返神经保护的对比研究OA

Objective:To compare the effect of transoral vestibular approach(TOVA)and transaxillary approach(TAA)on cervical lymph node dissection and recurrent laryngeal nerve(RLN)protection in robot-assisted radical thyroidectomy for thyroid cancer.Methods:Clinical data of 120 patients who underwent robot-assisted radical thyroidectomy at Tangdu Hospital,Fourth Military Medical University from May 2021 and November 2024 were retrospectively analyzed.Patients were divided into the TOVA group(n=68)and the TAA group(n=52)according to the surgical approach.After propensity score matching(PSM)at a 1∶1 ratio,50 patients were included in each group.Surgical parameters,postoperative pain levels,vocal cord function,swallowing function,and complication rates were compared between the two groups.Results:The TAA group had a significantly shorter operative time than the TOVA group(P＜0.05).No statistically significant differences were observed between the two groups in terms of length of hospital stay,intraoperative blood loss,or number of lymph nodes dissected(P＞0.05).At 6 h and 12 h after surgery,the TAA group showed lower visual analog scale(VAS)scores than the TOVA group(P＜0.05).At 1 month after surgery,both groups showed increased harmonic noise ratio(HNR)and decreased jitter,shimmer,and fundamental frequency.However,the TOVA group had a higher HNR and lower jitter,shimmer and fundamental frequency than the TAA group(P＜0.05).At 1 month after surgery,the TOVA group had a higher total score on the M.D.Anderson dysphagia inventory(MDADI)than the TAA group(P＜0.05).The overall complication rate at 1 month after surgery was not significantly different between the two groups(P＞0.05).Conclusion:Both TOVA and TAA are effective approaches for robot-assisted radical thyroidectomy,with comparable lymph node dissection efficacy.TAA is associated with shorter operative time and less postoperative pain,while TOVA results in less impairment to the RLN.In clinical practices,the operative approach should be selected based on patients' specific conditions.