Abstract:

Objective　To summarize the nursing points in patients undergoing transoral endoscopic thyroidectomy vestibular approach (TOETVA), and to provide practical experiences for such patients. Methods　A retrospective analysis was conducted on 62 patients with thyroid cancer in Sun Yat-sen Memorial Hospital, Sun Yat-sen University from March 2021 to February 2023 (62 cases of papillary thyroid carcinoma, 4 cases with chronic lymphocytic thyroiditis), including 2 men (3.2%) and 60 women (96.8%), with a median age of 30 (19, 49) years old. These patients underwent thyroid cancer resection under the multidisciplinary participation to formulate treatment and surgery plans. Nurses implemented preoperative oral management, implementation of health education, and psychological counseling, and postoperative strengthened targeted nursing measures for complications. Results　All 62 patients successfully underwent surgery, with a surgical duration ranging from 150 to 300 minutes, with an average of (174.20±28.85) minutes. Postoperatively, 13 cases experienced temporary hypoparathyroidism, 9 cases had temporary mental nerve injury, 3 cases had significant jaw swelling, lip edema, and blistering, 2 cases had recurrent laryngeal nerve injury, 2 cases had fluid accumulation, poor drainage, and infection, 1 case had chyle leakage, and 1 case had subcutaneous emphysema. After appropriate treatment and nursing care, the patients were discharged within 3 to 13 days postoperatively. Conclusion　Controlling the oral environment, paying attention to psychological care, and doing a good job in the observation and treatment of complications, are important measures to ensure that patients go through the perioperative period of TOETVA smoothly.

Key words:

Papillary thyroid carcinoma, Transoral vestibular approach, Perioperative care

摘要：

目的　总结经口腔前庭入路腔镜甲状腺手术（transoral endoscopic thyroidectomy vestibular approach，TOETVA）患者的护理要点，为该类患者护理提供实践经验。方法　回顾性分析2021年3月至2023年2月在中山大学孙逸仙纪念医院南院行TOETVA的62例甲状腺癌患者（62例甲状腺乳头状癌，4例伴慢性淋巴细胞性甲状腺炎），男2例（3.2%），女60例（96.8%）；年龄中位数为30（19，49）岁。在多学科的参与下制定治疗与手术方案，并实施甲状腺癌切除术，护理人员通过术前口腔管理、落实健康宣教及心理辅导，术后加强并发症针对性护理措施的护理方法。结果　62例患者均顺利完成手术，手术时间150～300（174.20±28.85）min。术后13例发生暂时性甲状旁腺功能减退症，9例发生暂时性下颏神经损伤；3例发生下颌肿胀明显，唇周肿胀、水泡；2例发生喉返神经损伤，2例发生积液、引流不畅、感染；1例发生乳糜漏，1例发生皮下气肿。经治疗护理，术后3～13 d出院。结论　控制口腔环境、关注心理护理、做好并发症的观察及处理等工作，是保证TOETVA患者顺利度过围手术期的重要措施。

关键词:

甲状腺乳头状癌, 经口腔前庭入路, 围手术期护理