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目的:探讨无充气经锁骨下入路腔镜手术（endoscopic thyroidectomy by gasless trans-subclavian approach，ETGTA）治疗甲状腺乳头状癌（papillary thyroid carcinoma，PTC）根治术的安全性和可行性。方法:回顾性分析2020年7月至2022年5月南京中医药大学附属南京市中医院甲状腺乳腺外科收治的148例PTC根治术患者的临床资料。根据手术入路不同，分为ETGTA组53例和小切口腔镜辅助手术（minimally invasive video-assisted thyroidectomy，Miccoli）组95例。记录2组手术时间、术中出血量、术后引流量、术后引流天数、术后住院时间、术后并发症及美容满意度等。使用统计学软件对结果进行分析，使用 t检验，Mann-Whitney U检验， χ 2检验等， P<0.05为差异具有统计学意义。 结果:2组年龄、性别比例、肿瘤最大径、肿瘤病灶数、肿瘤原发灶分期、手术方式差异无统计学意义（ P>0.05）。ETGTA组术后引流天数为（4.57±2.45）d，高于Miccoli组的（2.98±1.07）d（ P<0.01），但2组手术时间、术中出血量、术后引流量、术后住院时间差异无统计学意义（ P>0.05）。术后1个月、3个月ETGTA组术后吞咽不适发生率为（5.6%、0%），分别少于Miccoli组的（18.9%、7.4%）（ P=0.04， P=0.04）。术后1个月、3个月ETGTA组术后颈前区紧绷感或僵硬感发生率为（0%、0%），分别少于Miccoli组的（11.6%、8.4%）（ P=0.01， P=0.03）。ETGTA组术后美容满意度评分为（4.1±0.7）分，高于Miccoli组的（2.4±0.8）分（ P<0.01），但两组术后暂时性喉返神经损伤、术后3 d颈区疼痛、术后手足麻木及术后血肿情况差异无统计学意义（ P>0.05）。 结论:两种术式治疗PTC均安全、可行，其中ETGTA术式创口隐蔽，美容效果较佳，值得推广。

Objective:To investigate the safety and feasibility of endoscopic thyroidectomy by gasless trans subclavian approach (ETGTA) in treatment of papillary thyroid carcinoma (PTC) .Methods:The clinical data of 148 patients with PTC radical operation admitted to the Department of Thyroid and Breast Surgery, Nanjing Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine from Jul. 2020 to May. 2022 were retrospectively analyzed. They were divided into subclavian approach group (53 cases) and modified miccoli group (95 cases) according to different surgical approaches. The operation time, intraoperative bleeding volume, postoperative drainage flow, postoperative drainage days, postoperative hospital stay, postoperative complications and cosmetic satisfaction were recorded in the 2 groups. Statistical software was used to analyze the results, including t test, Mann-Whitney U test, χ2 test, etc. P<0.05 was considered statistically significant. Results:There were no significant differences in age, sex ratio, maximum diameter, stage, tumor lesion or surgical method between the 2 groups ( P>0.05). The postoperative drainage days increased in the subclavian group than in the modified miccoli group (4.57±2.45 vs. 2.98±1.07) ( P<0.01), but there was no statistical difference in operation time, intraoperative blood loss, postoperative drainage, or postoperative hospital stay between the two groups ( P>0.05). The incidence of swallowing discomfort at 1 month [5.6% (3/53) vs. 18.9% (18/95), P=0.04] and 3 months [0% (0/53) vs. 7.4% (7/95) , P=0.04], anterior cervical area tightness or stiffness at 1 month [0% (0/53) vs. 11.6% (11/95), P=0.01] and 3 months [0% (0/53) vs. 8.4% (8/95), P=0.03] were less than that of the modified miccoli group, and the difference was statistically significant (4.1±0.7 vs. 2.4±0.8) ( P<0.01), and the cosmetic satisfaction of the subclavian approach was higher than that of the modified miccoli group ( P<0.01). There was no significant difference in postoperative temporary recurrent laryngeal nerve injury, postoperative 3d neck pain, postoperative hand-foot numbness or postoperative hematoma between the two groups (all P>0.05) . Conclusion:The radical resection of papillary thyroid carcinoma without inflatable subclavicular approach is safe and feasible, with few postoperative complications and better cosmetic effect, which is worth popularizing.