经乳晕入路腔镜甲状腺切除术26例报道

Endoscopic thyroidectomy via areola of breasts approach in 26 cases

目的探讨经乳晕入路腔镜甲状腺切除术的可行性。方法2003年3月-2005年9月，采用经乳晕入路腔镜甲状腺切除术26例。结节位于甲状腺右叶13例，左叶10例，双侧叶结节1例，原发性甲状腺功能亢进（Ⅰ度）2例；单发结节9例，多发结节15例；囊性结节5例，实性结节13例，囊实混合性6例；结节直径1-4cm。术前诊断甲状腺腺瘤9例，结节性甲状腺肿15例，原发性甲状腺功能亢进2例，无临床诊断甲状腺癌。结果镜下手术成功25例，手术时间50-210min，平均112min，行甲状腺肿瘤摘除4例，单侧甲状腺大部分切除10例，双侧甲状腺大部分切除8例，甲状腺双叶次全切除加峡部切除3例；中转开放手术1例，为术中发现甲状腺癌并侵犯气管。病理诊断甲状腺腺瘤4例，结节性甲状腺肿18例，原发性甲状腺功能亢进2例，甲状腺癌2例。术后24—48h拔除引流管，无神经或甲状旁腺损伤等并发症。26例术后住院3—6d，平均4．2d。25例随访3～33个月，平均13个月，无局部复发，美容效果满意。2例甲状腺癌随访9、11个月，无复发转移。结论经乳晕入路腔镜甲状腺手术可行，近期效果满意，切口隐蔽。

Objective To explore the feasibility of endoscopic thyroidectomy through the approach of areola of breasts. Methods Endoscopic thyroidectomy via areola of breasts approach was carried out in 26 cases from March 2003 to September 2005. Thyroid nodules were right-sided in 13 cases, left-sided in 10 cases, bilateral in 1 case, and not palpable in 2 cases of hyperthyroidism （grade 1 ）, There were 9 cases of solitary nodule and 15 cases of multiple nodules, The nodules were cystic in 5 cases, solid in 13 cases, and mixed in 6 cases, with 1 - 4 cm in diameter, Preoperative diagnoses included 9 cases of thyroid adenoma, 15 cases of nodular goiter, and 2 cases of primary hyperthyroidism. Results The thyroidectomy was performed successfully under endoscope in 25 cases, with an operation time of 50 -210 min （mean, 112 min） , including 4 cases of tumor enucleation, 10 cases of unilateral partial thyroidectomy, 8 cases of bilateral partial thyroidectomy, and 3 cases of bilateral subtotal thyroidectomy with isthmus resection. A conversion to open surgery was required in 1 case owing to thyroid carcinoma with trachea involvement. Pathological findings showed 4 cases of thyroid adenoma, 18 cases of nodular goiter, 2 cases of primary hyperthyroidism, and 2 cases of thyroid carcinoma. The drainage tubes were removed at 24 - 48 hours after operation. No nerve or parathyroid injuries occurred. The length of postoperative hospital stay was 3 -6 d （mean, 4.2 d）. Follow-up observations in 25 cases for 3 -33 months （mean, 13 months） revealed no local recurrence. The patients were satisfied with cosmetic effects. The 2 cases of thyroid carcinoma were followed for 9 and 11 months, respectively, presenting no recurrence or metastasis. Conclusions Endoscopic thyroidectomy via areola of breasts approach is feasible and effective, offering satisfactory cosmetic outcomes.