目的 探讨经口联合颏下入路腔镜甲状腺全切除手术在甲状腺癌治疗中的应用效果。 方法 纳入2019年10月至2024年3月于赣南医科大学第一附属医院甲状腺疝外科接受甲状腺全部切除伴一侧中央区淋巴结清扫术的227例甲状腺乳头状癌患者。其中68例采用全腔镜下经口联合颏下入路（腔镜组），159例采用传统颈前开放入路（开放组）。通过回顾性病例分析，比较两组间的治疗效果。 结果 腔镜组与开放组相比，手术时长（149.65 ± 14.55）vs.（105.69 ± 20.23）min，术中出血量（21.03 ± 4.78）vs.（31.60 ± 5.61）mL，术后总引流量（161.03 ± 40.57）vs.（113.82 ± 35.13）mL，术后1 d血清钙水平（2.08 ± 0.14）vs.（2.15 ± 0.15）mmol/L，术后1 d血清全段甲状旁腺激素（iPTH）水平（14.17 ± 7.79）vs.（17.82 ± 7.48）pg/mL，暂时性甲状旁腺损伤比率51.47%（35/68） vs. 30.82%（49/159），并发症总例数比率54.41％（37/68）vs. 33.96%（54/159），比较差异均有统计学意义（P < 0.05）。两组术前血清iPTH、术前血清钙水平、清扫淋巴结数量、暂时性喉返神经损伤、术后出血、切口感染、颏下部位感觉减退，比较差异无统计学意义（P > 0.05）。 结论 与传统开放手术比较，全腔镜下经口联合颏下入路甲状腺全切除术疗效确切，长期安全性良好，但短期暂时性甲状旁腺功能减退风险较高，需强化术中对甲状旁腺的保护。

Objective To evaluate the therapeutic efficacy of endoscopic total thyroidectomy performed via a combined transoral and submental approach in patients with thyroid cancer Methods This study enrolled 227 patients diagnosed with papillary thyroid carcinoma （PTC） who underwent total thyroidectomy combined with unilateral central lymph node dissection at the Department of Thyroid and Hernia Surgery， the First Affiliated Hospital of Gannan Medical University， between October 2019 and March 2024. Of these patients， 68 were treated using the fully endoscopic combined transoral and submental approach （endoscopic group）， whereas 159 underwent the conventional open anterior cervical approach （open group）. A retrospective analysis was performed to evaluate and compare the therapeutic outcomes between the two groups. Results Surgical procedures were successfully completed in both groups without complications， and no additional incisions were required in the endoscopic group. Compared with the open surgery group， the endoscopic group had a longer operative duration， reduced intraoperative blood loss， and greater total postoperative drainage volume. Furthermore， on the first postoperative day， patients in the endoscopic surgery group exhibited lower levels of serum calcium and intact parathyroid hormone （iPTH）. The incidence of temporary parathyroid dysfunction was significantly higher in the endoscopic group （51.47%） than in the open surgery group （30.82%）， and this difference was statistically significant （P < 0.05）. No significant differences were found between the two groups regarding preoperative serum iPTH levels， preoperative serum calcium levels， number of dissected lymph nodes， incidence of temporary recurrent laryngeal nerve injury， postoperative hemorrhage， incision infection， or submental sensory loss （P > 0.05）. Conclusions Compared with traditional open surgery， total thyroidectomy via TOETSMVA under full endoscopy demonstrates comparable efficacy and favorable long-term safety. However， it is associated with a higher risk of transient hypoparathyroidism in the short term， highlighting the necessity for enhanced intraoperative protection of the parathyroid glands.