达芬奇机器人甲状腺手术中气管损伤并发症4例并文献复习

doi:10.6040/j.issn.1673-3770.0.2022.073

摘要/Abstract

摘要： 目的探讨达芬奇机器人甲状腺手术中气管损伤发生的原因、临床表现、诊断、治疗方法,以期提高对该并发症的认识。方法回顾性分析4例达芬奇机器人甲状腺手术气管损伤患者的临床资料并复习相关文献进行总结。结果达芬奇机器人甲状腺手术气管损伤缺乏特异性症状,临床多以咳嗽和颈胸部皮下气肿为首发症状,可伴有纵隔气肿或气胸,严重者可出现憋喘、呼吸困难等呼吸道阻塞症状。气管损伤进展较快,诊断或治疗不及时常导致严重后果。增强CT气管3D重建或支气管镜检查可明确诊断。结论达芬奇机器人甲状腺手术气管损伤是一种少见并发症,但可能严重威胁患者生命。达芬奇机器人甲状腺手术患者出现皮下气肿和呼吸变化要考虑到气管损伤的可能。

关键词: 达芬奇机器人手术系统, 甲状腺切除术, 并发症, 气管损伤

Abstract: Objective To investigate the causes, clinical characteristics, diagnosis and treatment of tracheal injury in da Vinci robotic thyroidectomy and improve the understanding of this complication. Methods Four patients with tracheal injury in da Vinci robotic thyroidectomy were retrospectively analyzed, and relevant literature was reviewed. Results The clinical manifestations of tracheal injury in da Vinci robot thyroidectomy lack specificity; cough and subcutaneous emphysema of neck/chest are usually the initial presentation, which may be accompanied by pneumomediastinum or pneumothorax. Respiratory obstruction symptoms such as wheezing and dyspnea may occur in severe cases. Tracheal injury progresses rapidly, and delayed diagnosis or treatment may lead to serious consequences. Enhanced computed tomography and three-dimensional reconstruction of the trachea or bronchoscopy can confirm the diagnosis. Conclusion Tracheal injury in da Vinci robotic thyroidectomy is a rare but life-threatening complication. Subcutaneous emphysema and respiratory changes in patients who underwent da Vinci robotic thyroidectomy should indicate the possibility of tracheal injury.

Key words: Da Vinci robotic surgical system, Thyroidectomy, Complications, Tracheal injury

中图分类号:

R736.1

岳涛,庄大勇,周鹏,李小磊,徐婧,朱见,贺青卿. 达芬奇机器人甲状腺手术中气管损伤并发症4例并文献复习[J]. 山东大学耳鼻喉眼学报, 2023, 37(3): 46-50.

YUE Tao, ZHUANG Dayong, ZHOU Peng, LI Xiaolei, XU Jing, ZHU Jian, HE Qingqing. The complications of tracheal injury in da Vinci robotic thyroidectomy: four case reports and literature review[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(3): 46-50.

参考文献

[1] 王丹, 贺青卿. 达芬奇机器人甲状腺手术的进展与展望[J]. 中国普外基础与临床杂志, 2021, 28(10): 1261-1265. doi:10.7507/1007-9424.202107123
[2] 岳涛, 庄大勇, 贺青卿, 等. 达芬奇机器人甲状腺手术并发症及防治[J]. 国际外科学杂志, 2017, 44(12): 850-853. doi:10.3760/cma.j.issn.1673-4203.2017.12.015 YUE Tao, ZHUANG Dayong, HE Qingqing, et al. Complications and prevention of robot da vinci thyroid surgery[J]. International Journal of Surgery, 2017, 44(12): 850-853. doi:10.3760/cma.j.issn.1673-4203.2017.12.015
[3] Grewal H, Dangayach N, Ahmad U, et al. Treatment of tracheobronchial injuries: a contemporary review[J]. Chest, 2019, 155(3): 595-604. doi: 10.1016/j.chest.2018.07.018
[4] Chae S, Min SY, Park WS. Comparison study of robotic thyroidectomies through a bilateral axillo-breast approach and a transoral approach[J]. J Laparoendosc Adv Surg Tech A, 2020, 30(2): 175-182. doi:10.1089/lap.2019.0585
[5] Maurer E, Wächter S, Albers M, et al. Transaxillary robot-assisted thyroidectomy - results and acceptance of a new surgical technique[J]. Zentralbl Chir, 2018, 143(4): 353-360. doi:10.1055/a-0647-7168
[6] Kwak J, Kim SJ, Xu Z, et al. Robotic completion thyroidectomy via the bilateral axillo-breast approach[J]. J Clin Med, 2021, 10(8): 1707. doi:10.3390/jcm10081707
[7] Ban EJ, Yoo JY, Kim WW, et al. Surgical complications after robotic thyroidectomy for thyroid carcinoma: a single center experience with 3, 000 patients[J]. Surg Endosc, 2014, 28(9): 2555-2563. doi:10.1007/s00464-014-3502-1
[8] Materazzi G, Fregoli L, Papini P, et al. Robot-assisted transaxillary thyroidectomy(RATT): a series appraisal of more than 250 cases from Europe[J]. World J Surg, 2018, 42(4): 1018-1023. doi:10.1007/s00268-017-4213-2
[9] 黄晓明, 梁发雅, 余诗桐. 内镜下甲状腺乳头状腺癌的手术[J]. 山东大学耳鼻喉眼学报, 2016(2): 13-16. doi:10.6040/j.issn.1673-3770.1.2016.04 HUANG Xiaoming, LIANG Faya, YU Shitong. Surgical treatment of papillary thyroid carcinoma under endoscopy[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2016(2): 13-16. doi:10.6040/j.issn.1673-3770.1.2016.04
[10] 李良辉, 吴国洋, 卢毅卓, 等. 腋窝径路与胸乳径路腔镜甲状腺手术的比较[J]. 中国内镜杂志, 2013, 19(10): 1036-1040. LI Lianghui, WU Guoyang, LU Yizhuo, et al. Comparative study of the axillary approach and breast approach endoscopic thyroidectomy[J]. China Journal of Endoscopy, 2013, 19(10): 1036-1040.
[11] 刘溦薇, 周鸣, 赵吉, 等. 腔镜甲状腺手术与传统甲状腺手术后的并发症比较[J]. 中国普外基础与临床杂志, 2018, 25(3): 323-327. doi:10.7507/1007-9424.201708032 LIU Weiwei, ZHOU Ming, ZHAO Ji, et al. Comparative study on complications of endoscopic thyroidectomy versus conventional thyroidectomy[J]. Chinese Journal of Bases and Clinics in General Surgery, 2018, 25(3): 323-327. doi:10.7507/1007-9424.201708032
[12] Cordón C, Fajardo R, Ramírez J, et al. A randomized, prospective, parallel group study comparing the Harmonic Scalpel to electrocautery in thyroidectomy[J]. Surgery, 2005, 137(3): 337-341. doi:10.1016/j.surg.2004.09.011
[13] He Q, Zhu J, Zhuang D, et al. Robotic lateral cervical lymph node dissection via bilateral axillo-breast approach for papillary thyroid carcinoma: a single-center experience of 260 cases[J]. J Robot Surg, 2020, 14(2): 317-323. doi:10.1007/s11701-019-00986-3
[14] 赖建勤, 张迪, 黄华平, 等. 完全腔镜甲状腺手术的少见并发症及其预防策略[J]. 中国普通外科杂志, 2019, 28(11): 1414-1420. doi:10.7659/j.issn.1005-6947.2019.11.015 LAI Jianqin, ZHANG Di, HUANG Huaping, et al. Unusual complications of totally endoscopic thyroidectomy and its prevention strategies[J]. Chinese Journal of General Surgery, 2019, 28(11): 1414-1420. doi:10.7659/j.issn.1005-6947.2019.11.015
[15] Tae K. Robotic thyroid surgery[J]. Auris Nasus Larynx, 2021, 48(3): 331-338. doi:10.1016/j.anl.2020.06.007
[16] AK AK, Anjum F. Tracheobronchial Tear[M]. Treasure Island(FL): StatPearls Publishing. 2021.
[17] Farley LS, Schlicksup KE. Tracheal Injury[M]. Treasure Island(FL): StatPearls Publishing. 2021.
[18] 王健男, 王恺铖, 黄海东, 等. 气管支气管损伤的诊治现状及展望[J]. 中国呼吸与危重监护杂志, 2021, 20(3): 219-223. doi:10.7507/1671-6205.202003024 WANG Jiannan, WANG Kaicheng, HUANG Haidong, et al. Management of tracheobronchial injuries: a review of literature[J]. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(3): 219-223. doi:10.7507/1671-6205.202003024
[19] Zhao Z, Zhang T, Yin X, et al. Update on the diagnosis and treatment of tracheal and bronchial injury[J]. J Thorac Dis, 2017, 9(1): E50-E56. doi:10.21037/jtd.2017.01.19
[20] Kaloud H, Smolle-Juettner FM, Prause G, List W, et al. Iatrogenic ruptures of the tracheobronchial tree[J]. Chest, 1997, 112(3): 774-778. doi: 10.1378/chest.112.3.774
[21] Putz L, Muschart X, Borgers G, et al. Tracheal damage[J]. B-ENT, 2016, 26(2): 87-102.
[22] Lee SK, Kim DH, Lee SK, et al. Does surgical repair still have a role for iatrogenic tracheobronchial rupture? clinical analysis of a thoracic surgeon's opinion[J]. Ann Thorac Cardiovasc Surg, 2016, 22(6): 348-353. doi:10.5761/atcs.oa.16-00189
[23] 王丹, 贺青卿, 朱见, 等. 双侧腋窝乳晕入路达芬奇机器人甲状腺手术并发症特征分析[J]. 中华耳鼻咽喉头颈外科杂志, 2021, 56(4): 363-368. doi:10.3760/cma.j.cn115330-20200824-00691 WANG Dan, HE Qingqing, ZHU Jian, et al. Complications of Da Vinci robot thyroid surgery by bilateral axillo-breast approach[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2021, 56(4): 363-368. doi:10.3760/cma.j.cn115330-20200824-00691
[24] 李小磊, 贺青卿, 庄大勇, 等. 双侧腋窝乳晕入路机器人甲状腺手术单中心1 000例报告[J]. 中华外科杂志, 2021, 59(11): 918-922. doi:10.3760/cma.j.cn112139-20201218-00866 LI Xiaolei, HE Qingqing, ZHUANG Dayong, et al. Outcomes of 1 000 cases of robotic thyroidectomy by bilateral axillo-breast approach: a retrospective study in a single center[J]. Chinese Journal of Surgery, 2021, 59(11): 918-922. doi:10.3760/cma.j.cn112139-20201218-00866
[25] Shew M, Boyd C, Kraft S. Delayed multifocal tracheal injury following thyroidectomy: a case report and review of the literature[J]. Cureus, 2020, 12(5): e8164. doi:10.7759/cureus.8164
[26] Stevens MN, Bolduan A, Gelbard A. Delayed tracheal perforation following total thyroidectomy[J]. Laryngoscope, 2022, 132(1): 17-19. doi:10.1002/lary.29534
[27] 王平, 燕海潮. 腔镜下全乳晕入路甲状腺腺叶切除的方法: 王氏七步法[J]. 中国普通外科杂志, 2017, 26(5): 541-546. doi:10.3978/j.issn.1005-6947.2017.05.001 WANG Ping, YAN Haichao. Endoscopic thyroid lobectomy via bilateral areolar approach—Wang's seven-step method[J]. Chinese Journal of General Surgery, 2017, 26(5): 541-546. doi:10.3978/j.issn.1005-6947.2017.05.001

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