腔镜辅助颈部小切口甲状腺手术应用于甲状腺微小癌的探讨

Minimally invasive video-assisted thyroidectomy on thyroid microcarcinoma

目的探讨腔镜辅助颈部小切口甲状腺手术对于甲状腺微小癌的可行性、临床效果。方法回顾性分析我院行腔镜辅助颈部小切口甲状腺术式切除甲状腺微小癌9例临床资料。结果除1例中转行开放手术外，余手术均获成功，术后皮下积液1例，切缘皮肤烧伤1例，无喉返神经损伤、出血、低血钙、喉上神经损伤等并发症；术后随访3～37个月，行甲状腺超声、CT、甲状腺核素扫描检查无复发、转移。结论对低危组、无颈部淋巴结转移的分化型甲状腺微小癌腔镜辅助颈部小切口甲状腺手术是安全、可行的，美容效果良好，可与传统手术治疗效果相同。

Objective To explore the feasibility and efficiency of minimally invasive video-assisted thyroidectomy on thyroid microcarcinoma, and sum up the experiences. Methods 9 patients with thyroid microcarcinoma who underwent the minimally invasive video-assisted thyroidectomy from Jan 2006 to Feb 2009, were retro- spectively studied. Results All of the patients, except 1 case converting to open thyroidectomy, underwent the minimally invasive video-assisted thyroidectomy successfully. The subcutaneous hydrops occurred in 1 patient. The skin burns around the incisions occurred in 1 patient. There were no complications of recurrent laryngeal nerve injuries, neck hematoma, hypocalcemia, or superior laryngeal nerve injuries. The follow-up period of 15 cases were from 3 months to 37 mouths. There were no evidences of recurrence and metastasis by both postoperative ultrasonie/CT examination and radioiodine seintigraphy. Conclusions The minimally invasive video-assisted thyroidectomy is safe and feasible （ similar to the traditional thyroideetomy）, of gratifying cosmetic results, for low-risk differentiated thyroid microcarcinoma without lymph node metastasis. For the median-risk or high-risk, more patients, comparative studies and long follow-ups are necessary to draw definitive conclusions in terms of its recurrence and survival rate.