目的：研究前锯肌平面阻滞（SAPB）在经双侧腋窝乳晕入路（BABA）达芬奇机器人辅助甲状腺手术中的临床价值。 方法：选择 2022 年 2 月—2022 年 5 月于本院择期行 BABA 入路机器人辅助甲状腺手术 70 例患者为研究对象。利用随机数 字表法分为 GS 组（静脉全身麻醉复合 SAPB）和 G 组（静脉全身麻醉），每组 35 例。记录两组患者切皮前（T0）、Trocar 置入（T1）、手术腔道冲洗（T2）和拔管后 5 min（T3）四个时点的 MAP、HR，记录两组患者术中舒芬太尼、丙泊酚、瑞 芬太尼用量及术毕苏醒拔管时间。记录两组患者术后 2 h、6 h、12 h、24 h、48 h 五个时间点疼痛数字评分（NRS）以及不良 反应发生状况。结果：两组患者 T0、T1、T2、T3 四个不同时点 MAP 差异均无统计学意义（P>0.05）；两组患者 HR 比较， T0、T1 时差异无统计学意义（P>0.05），T2、T3 时 GS 组明显低于 G 组（P<0.05）。与 G 组相比，GS 组术中舒芬太尼、丙 泊酚及瑞芬太尼用量明显减少（P<0.05），术毕苏醒拔管时间缩短（P<0.05），术后 2 h、6 h、12 h、24 h、48 h NRS 评分明 显降低（P<0.05）。两组患者术后不良反应状况类似（P>0.05）。结论：全身麻醉联合 SAPB 可以降低 BABA 入路机器人辅 助甲状腺手术患者术中手术腔道冲洗及苏醒后的 HR，减轻患者应激反应，减少术中阿片类药物及镇静药物用量，降低患者 术后疼痛评分，提高患者舒适度，且无相关并发症及不良反应，可为患者带来较好的临床效果，值得临床推广。

Objective: To evaluate the clinical efficacy of serratus anterior plane block (SAPB) in patients undergoing Da Vinci robotassisted thyroidectomy via the bilateral axillo-breast approach (BABA). Methods: 70 patients scheduled for robot-assisted thyroidectomy via BABA from February 2022 to May 2022 were enrolled. They were divided into the GS group (n=35, receiving general anesthesia combined with SAPB) and the G group (n=35, receiving general anesthesia alone) using a random number table. Mean arterial pressure (MAP) and heart rate (HR) were recorded at 4 timepoints: pre-incision (T0), Trocar placement (T1), surgical cavity irrigation (T2), and 5 minutes after extubation (T3). Intraoperative consumption of sufentanil, propofol, and remifentanil, as well as extubation time, were recorded. Postoperative Numerical Rating Scale (NRS) scores and adverse events were assessed at 2, 6, 12, 24, and 48 hours after surgery. Results: No significant differences in MAP were observed between the two groups at any timepoint (P>0.05). HR in the GS group was significantly lower than the G group at T2 and T3, but there was no significant difference at T0 and T1 between the two groups (P<0.05). The GS group required significantly lower doses of sufentanil, propofol, and remifentanil (P<0.05), shorter extubation time (P<0.05), lower NRS scores at 2, 6, 12, 24, and 48 hours after surgery than the G group (P<0.05). Rates of adverse event were comparable between the two groups (P>0.05). Conclusion: General anesthesia combined with SAPB can lower HR, alleviate stress response, reduce opioid and sedative requirements, reduce postoperative pain scores, and improve patient comfort levels in patients undergoing robot-assisted thyroidectomy via BABA without increasing block-related complications, which is worth of clinical promotion.

基金项目：济南市科学技术局临床医学科技创新计划（202019018） 

Foundation Item: Clinical Medical Science and Technology Innovation Program of Jinan Science and Technology Bureau (202019018)  

引用格式：张伟，王飞，高成杰 . 前锯肌平面阻滞促进腋乳入路机器人辅助甲状腺手术患者的快速康复（附手术视频）[J]. 机器人外科学杂志（中 英文），2025，6（4）：585-590. 

Citation: ZHANG W, WANG F, GAO C J. Serratus anterior plane block facilitates enhanced recovery in patients undergoing robot-assisted  thyroidectomy via the axillo-breast approach (with surgical video) [J]. Chinese Journal of Robotic Surgery, 2025, 6(4): 585-590. 

通讯作者（Corresponding Author）：高成杰（GAO Chengjie），Email：gaochj@hotmail.com

[1] 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 1000 例报告 [J]. 中华外科杂志 , 2021, (11): 918-922. 

[2] 厉彦辰 , 郑鲁明 , 朱见 , 等 . 机器人辅助下经 BABA 入路甲状腺手术助 手学习曲线分析 [J]. 机器人外科学杂志 ( 中英文 ), 2021, 2(6): 463-470. 

[3] 潘锋 . 多模式镇痛是加速康复外科疼痛管理的发展趋势——访浙 江大学医学院附属第二医院严世贵教授 [J]. 中国当代医药 , 2019, 26(12): 1-3. 

[4] Blanco R, Parras T, Mcdonnell J G, et al. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block[J]. Anaesthesia, 2013, 68(11): 1107-1113. 

[5] Patel K M, Guzman K D, Wise J, et al. Serratus anterior plane block versus intercostal nerve blocks in thoracic surgery: a retrospective analysis[J]. J Cardiothorac Vasc Anesth, 2022, 36(8 Pt A): 2841-2842. 

[6] Sepolvere G, Tognu A, Tedesco M, et al. Successful use of continuous deep serratus plane block for pneumothorax and rib fractures management[J]. Minerva Anestesiol, 2021, 87(6): 733-734. 

[7] 董芬 , 张彪 , 单广良 . 中国甲状腺癌的流行现状和影响因素 [J]. 中国 癌症杂志 , 2016, 26(1): 47-52. 

[8] 姚承志 , 张敏 , 曾雨可 , 等 . 中国甲状腺癌发病和死亡趋势分析与预 测 [J]. 中华流行病学杂志 , 2023, 44(6): 917-923. 

[9] Nabhan F, Dedhia P H, Ringel M D. Thyroid cancer, recent advances in diagnosis and therapy[J]. Int J Cancer, 2021, 149(5): 984-992. 

[10] ZHANG R J, CHEN Y L, DENG X, et al. Comparison of bilateral axillobreast approach robotic thyroidectomy and open thyroidectomy for papillary thyroid carcinoma [J]. Journal of Robotic Surgery, 2023, 17(5): 1933-1942. 

[11] Tae K. Robotic thyroid surgery[J]. Auris Nasus Larynx, 2021, 48(3): 331-338. 

[12] Wattier Jean-Michel, Robert C, Andrieu G, et al. Chronic postthyroidectomy pain: Incidence, typology, and risk factors[J]. Anaesth Crit Care Pain Med, 2016, 35(3): 197-201. 

[13] 高安 , 康芳 . 术后慢性疼痛的研究进展 [J]. 中国临床保健杂志 , 2021, 24(2): 279-283. 

[14] Slinchenkova K, Lee K, Choudhury S, et al. A review of the paravertebral block: benefits and complications[J]. Curr Pain Headache Rep, 2023, 27(8): 203-208. 

[15] 刘慧丽 , 李民 . 加速康复外科方案对肺部手术患者阿片类药物用量 的影响 [J]. 中华医学杂志 , 2023, 103(41): 3251. 

[16] 秦志祥 , 李春雨 , 李青青 , 等 . 确定前锯肌下筋膜平面阻滞范围 : 尸 体标本解剖 [J]. 中华麻醉学杂志 , 2020, 40(10): 1255-1257. 

[17] Armissoglio G, Serchan P, Griseto L, et al. Ultrasound guided Interpectoral, pectoserratus and serratus anterior plane blocks[J]. Med Ultrason, 2023, 25(1): 98-103. 

[18] 汤颜鞠 , 葛亚丽 . 前锯肌平面阻滞与胸椎旁阻滞用于胸外科手术 患者术后镇痛效果的 Meta 分析 [J]. 临床麻醉学杂志 , 2022, 38(9): 958-964. 

[19] Jayadeep I, Srinivasan G, Sethuramachandran A, et al. Comparison of the analgesic efficacy of ultrasound-guided superficial serratus anterior plane block with deep serratus anterior plane block in patients undergoing modified radical mastectomy: a randomized clinical trial[J]. Cureus, 2022, 14(10): e30828. 

[20] SHI K J, CHEN Y, LIU L, et al. Comparison of the effect of different volumes ropivacaine on deep serratus anterior plane block in patients undergoing breast surgery: a prospective randomized double-blinded trial[J]. Ann Palliat Med, 2021, 10(6): 6104-6111. 

[21] Edwards J T, Langridge X T, Cheng G S, et al. Superficial vs. deep serratus anterior plane block for analgesia in patients undergoing mastectomy: a randomized prospective trial[J]. J Clin Anesth, 2021. DOI: 10.1016/ j.jclinane.2021.110470. 

[22] HUANG L D, ZHENG L Y, WU B J, et al. Effects of ropivacaine concentration on analgesia after ultrasound-guided serratus anterior plane block: a randomized double-blind trial[J]. J Pain Res, 2020. DOI: 10.2147/ JPR.S229523. 

[23] 曾晓平 , 施宏 , 吴玮 , 等 . 超声引导下前锯肌平面阻滞的研究进展 [J]. 临床麻醉学杂志 , 2021, 41(3): 277-279. 

[24] Szamborski M, Janc J, Leśnik P, et al. Ultrasound-guided pectoserratus plane block and superficial serratus anterior plane block for subcutaneous implantable cardioverter-defibrillator implantation: a comparative study[J]. Med Sci Monit, 2023, 21(29): e940541. 

[25] Jack J M, McLellan E, Versyck B, et al. The role of serratus anterior plane and pectoral nerves blocks in cardiac surgery, thoracic surgery and trauma: a qualitative systematic review[J]. Anaesthesia, 2020, 75(10): 1372-1385.