无充气经锁骨下侧方入路——更适合甲状旁腺解剖的手术方式

doi:10.16139/j.1007-9610.2025.06.08

摘要/Abstract

摘要：

目的：探索无充气经锁骨下侧方入路在甲状旁腺手术中的安全性及有效性。方法：采用回顾性同期对照的方法，收集2024年11月—2025年4月在上海交通大学医学院附属瑞金医院住院行手术治疗的原发性甲状旁腺功能亢进病人共53例，其中20例无充气经锁骨下侧方入路手术为试验组，对照组按照性别、年龄、肿瘤大小、术前甲状旁腺激素等为匹配条件，选取相同时间段手术的常规颈前区入路的病人1∶1配比，作病例对照研究。比较两组的手术疗效、术后疼痛、并发症发生率和美容效果等指标。结果：两组的手术时间、术中出血量、住院时间及手术成功率比较差异均无统计学意义（P>0.05）。住院期间术后并发症（包括声音嘶哑、饮水呛咳、切口感染、切口血肿及发热）的发生率及术后疼痛评分两组间差异均无统计学意义（P>0.05）。在术后1个月的瘢痕评估中，试验组的评分低于对照组（P<0.05）。试验组的美容效果满意度评分明显优于对照组（P<0.01）。结论：无充气经锁骨下侧方入路甲状旁腺切除术作为一种更适合甲状旁腺解剖特征的新型手术方式，具有较好的有效性及安全性，未显著增加手术风险。在安全切除病灶的同时，颈前不遗留手术瘢痕，具有美容效果好的优势。作为一种安全可行的手术方式，为甲状旁腺手术病人提供了一个理想的新选择。

关键词: 无充气经锁骨下入路, 甲状旁腺切除术, 甲状旁腺功能亢进, 侧方入路

Abstract:

Objective To explore the safety and effectiveness of gasless subclavicular lateral approach in parathyroid surgery. Methods A retrospective comparative study was conducted to collect a total of 53 patients with primary hyperparathyroidism who underwent surgical treatment at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from November 2024 to April 2025. Among them, 20 patients underwent subclavicular lateral approach surgery (experimental group). The control group was matched 1∶1 based on criteria including gender, age, tumor size, and preoperative （parathyroid hormone, PTH） levels. Twenty patients who underwent conventional anterior cervical approach during the same period were selected for a case-control study. The surgical efficacy, postoperative incision pain, incidence of complications, and cosmetic effects between two groups were compared. Results There was no statistically significant difference (P>0.05) in operative time, intraoperative bleeding, hospitalization time, and surgical efficiency between the two groups. There was no statistically significant difference in the incidence of postoperative complications such as hoarseness, water choking, incision infection, incision hematoma, fever, and postoperative pain scores between the two groups during hospitalization (P>0.05). In the scar assessment one month after surgery, the score of the experimental group was lower than that of the control group (P<0.05). The satisfaction score of the beauty effect in the experimental group was significantly better than that in the control group (P<0.01). Conclusions Gasless subclavicular lateral approach for parathyroidectomy, as an emerging and anatomically optimized surgical technique, has good effectiveness and safety, without significantly increasing surgical risks. It can safely remove lesions without leaving surgical scars in the anterior neck, and has the advantage of good cosmetic effects. As a safe and feasible surgical method, it provides a new and ideal choice for patients undergoing parathyroid surgery.

Key words: Gasless subclavicular approach, Parathyroidectomy, Hyperparathyroidism, Lateral approach

中图分类号:

R653

冯雯卿, 高浩基. 无充气经锁骨下侧方入路——更适合甲状旁腺解剖的手术方式[J]. 外科理论与实践, 2025, 30(06): 503-508.

FENG Wenqing, GAO Haoji. Gasless subclavicular lateral approach: an anatomically tailored surgical technique for parathyroid surgery[J]. Journal of Surgery Concepts & Practice, 2025, 30(06): 503-508.

图/表 7

表 1

图 1

图 2

图3

表2

图4

表3

参考文献 15

[1]	MINISOLA S, ARNOLD A, BELAYA Z, et al. Epidemio-logy, pathophysiology, and genetics of primary hyperparathyroidism[J]. J Bone Miner Res, 2022, 37(11):2315-2329. doi: 10.1002/jbmr.4665 URL
[2]	SHAKER J L, WERMERS R A. The eucalcemic patient with elevated parathyroid hormone levels[J]. J Endocr Soc, 2023, 7(4):bvad013.
[3]	DIALLO I, FALL CA, NDIAYE B, et al. Primary hyperparathyroidism and pancreatitis: a rare association with multiple facets[J]. Int Sch Res Notices, 2016, 2016:7294274.
[4]	ARESTA C, PASSERI E, CORBETTA S. Symptomatic hypercalcemia in patients with primary hyperparathyroi-dism is associated with severity of disease, polypharmacy, and comorbidity[J]. Int J Endocrinol, 2019, 2019:7617254.
[5]	ARORA A, GARAS G, TOLLEY N. Robotic parathyroid surgery: current perspectives and future considerations[J]. ORL J Otorhinolaryngol Relat Spec, 2018, 80(3-4):195-203. doi: 10.1159/000488355 URL
[6]	SHAN Y, ZHANG G, YU Z, et al. Transareola single-site endoscopic thyroidectomy: clinical study of 28 cases with thyroid nodule[J]. J Laparoendosc Adv Surg Tech A, 2013, 23(7):584-587. doi: 10.1089/lap.2012.0386 URL
[7]	ROH M R. The SCAR (scar cosmesis assessment and rating) scale: new evaluation method for postoperative scars[J]. Br J Dermatol, 2016, 175(6):1151-1152. doi: 10.1111/bjd.14989 pmid: 27996133
[8]	卢星, 黄晓明, 孙伟, 等. 经胸前入路无注气内镜下甲状腺手术与传统手术创伤比较的随机对照研究[J]. 中华耳鼻咽喉头颈外科杂志, 2010, 45(11):895-898.
	LU X, HUANG X M, SUN W, et al. Comparison of the surgical stress between endoscopic thyroidectomy via anterior chest approach and conventional thyroidectomy[J]. Chin J Otorhinolaryngol Head Neck Surg, 2010, 45(11):895-898.
[9]	田文, 贺青卿, 廖泉, 等. 腔镜和机器人甲状旁腺手术中国专家共识(2024版)[J]. 中国实用外科杂志, 2024, 44(2):125-133.
	TIAN W, HE Q Q, LIAO Q, et al. Chinese expert consensus on surgical practice of endoscopic and robotic parathyroid surgery(2024 edition)[J]. Chin J Pract Surg, 2024, 44(2):125-133.
[10]	HAN S H, JI J Y, CHA W, et al. Cumulative sum analysis of the learning curve for robotic retroauricular thyroidectomy[J]. Gland Surg, 2023; 12(1):30-38. doi: 10.21037/gs-22-365 pmid: 36761485
[11]	BARCZYŃSKI M, BRÄNSTRÖM R, DIONIGI G, et al. Sporadic multiple parathyroid gland disease—a consensus report of the European Society of Endocrine Surgeons (ESES)[J]. Langenbecks Arch Surg, 2015, 400(8):887-905. doi: 10.1007/s00423-015-1348-1 URL
[12]	ZHANG W, WU Q H, JIANG Z G, et al. Subcutaneous dissection area contributes less to endoscopic thyroidectomy-related invasiveness[J]. Surg Endosc, 2016, 30(10):4272-4278. doi: 10.1007/s00464-015-4742-4 pmid: 26743105
[13]	郭雅文, 郑传铭, 葛明华. 无充气腋窝入路腔镜甲状腺手术的应用、创新与质控[J]. 外科理论与实践, 2025, 30(1):1-6.
	GUO Y W, ZHENG C M, GE M H. Application, innovation, and quality control of endoscopic thyroidectomy by gasless unilateral axillary approach[J]. J Surg Concepts Pract, 2025, 30(1):1-6.
[14]	SARKIS LM, ZAIDI N, NORLÉN O, et al. Bilateral recurrent laryngeal nerve injury in a specialized thyroid surgery unit: would routine intraoperative neuromonitoring alter outcomes?[J]. ANZ J Surg, 2017; 87(5):364-367. doi: 10.1111/ans.12980 pmid: 25648744
[15]	ALVARADO L, SHARMA N, LERMA R, et al. Parathyroidectomy versus cinacalcet for the treatment of secondary hyperparathyroidism in hemodialysis patients[J]. World J Surg, 2022; 46(4):813-819. doi: 10.1007/s00268-022-06439-7 URL

Item		Experimental group(n=20)	Control group(n=20)	Statistic value	P value
Age(year)		58.4±11.7	57.3±12.1	t=0.292	0.985
Gender[n(%)]	female	15（75.0）	15（75.0）	χ²=0	1
Tumor longest diameter (cm)		1.5±0.6	1.5±0.6	t=-0.210	0.917
Tumor location（left/right）	Left	10（50.0）	11（55.0）	χ²=0.1	0.752
Tumor location (upper/lower)	Upper	7（35.0）	5（25.0）	χ²=0.476	0.490
Operation time (min)		50.8±13.3	53.7±21.5	t=-0.521	0.058
Intraoperative blood loss (mL)		13.3±13.8	11.8±12.1	t=0.365	0.706
Postoperative hospital stay (d)		2.9±0.8	3.0±0.9	t=-0.402	0.623
PTH（ng/L）
Preoperative		302.2±199.6	279.5±184.1	t=0.372	0.665
Postoperative		40.6±19.8	40.9±33.2	t=-0.031	0.976
Serum calcium（mmol/L）
Preoperative		2.7±0.2	2.8±0.4	t=-0.798	0.275
Postoperative		2.3±0.2	2.3±0.1	t=0.162	0.522

Item	Experimental group(n=20)	Control group(n=20)	Statistic value	P value
Temporary hoarseness	2(10.0)	2(10.0)	χ²=0	1.00
Choking while drinking	1(5.0)	2(10.0)	χ²=0.36	0.548
VAS of the first day after surgery	2.8±0.6	2.6±0.5	t=1.192	0.511

Item	Experimental group(n=20)	Control group(n=20)	t value	P value
One-month postoperative VAS	0.4±0.6	0.6±0.6	-1.057	0.801
SCAR scale score	3.0±0.5	3.4±0.7	-1.981	0.03
Satisfaction score	4.9±0.4	4.6±0.6	1.897	0.001