腔镜技术在甲状腺结节治疗中的应用与评价

Application and evaluation of endoscopic technique in the surgical treatment of thyroid nodules

甲状腺结节是甲状腺外科的常见病,为了切除病灶或明确诊断,大多数甲状腺结节需外科手术治疗。腔镜技术在甲状腺外科的应用缩小或避免了开放手术对颈部外观的不良影响。随着手术技术的进步,腔镜下已能完成几乎所有方式的甲状腺手术,其中腔镜下甲状腺次全切除术是应用最多的手术方式。常用的手术入路包括经颈前小切口的腔镜辅助甲状腺手术以及经胸乳入路或经腋窝入路的完全腔镜下甲状腺手术。对于低危的分化型甲状腺癌,腔镜下甲状腺近全切除术代替甲状腺全切除,疗效确切,安全性高,但腔镜下颈淋巴结清扫的效果尚有争议。

Thyroid nodules are common in clinical practice. Majority of patients with thyroid nodules need surgical treatment in order to remove the focus or to acquire a final diagnosis. The postoperative cervical appearance could be improved with the application of endoscopic technique in thyroid surgery. With the improvement of the operative technique, ahnost all types of thyroidectomy could be completed under endoscope. Endoscopic subtotal thyroidectomy is the most common method in the treatment of thyroid nodules. The common approaches of endoscope include video-assisted thyroidectomy via cervical small incision and total endoscope thyroidectomy via breast approach or axillary approach. Comparing with the total thyroidectomy, endoscopic near-total thyroidectomy for low risk differentiated thyroid carcinoma could get better safety, lower incidence of recurrent laryngeal nerve paralysis and the same therapeutic effect. But the clearance of cervical lymph nodes is still controversial. On account of its remarkably cosmetic advantages, endoscopic operation has become the preferred method for the treatment of thyroid nodules.