腋乳入路腔镜甲状腺切除治疗甲状腺功能亢进

Endoscopic thyroidectomy via axillo-breast approach for patients with Graves' disease

目的总结腋乳入路下腔镜治疗甲状腺功能亢进(甲亢)的经验。方法 33例甲亢患者,经腋乳入路腔镜下行甲状腺切除术,术中行一侧甲状腺全切,对侧甲状腺次全切除术,保留残余甲状腺组织6～8g。结果 33例手术均成功,无中转开放手术。手术时间130～260min,平均202.1min;术中出血量20～200mL,平均59.4mL。术后暂时性低钙血症2例,暂时性声嘶1例,无术中、术后大出血等并发症。术后恢复良好,近期随访美容效果满意。随访6～12个月,平均8.1个月,3例复发,5例出现甲状腺功能低下。结论腔镜治疗甲亢技术安全、可行。

[Objective] To summarize the experience of endoscopic thyroidectomy via axillo-breast approach and evaluate its feasibility and outcomes. [Methods] From July 2005 to November 2009, 33 patients （30 women and 3 men） with Graves＇ disease were included in this study. Total thyroidectomy on one side and subtotal thyroidectomy on the other side which left behind 6~8 g of thyroid remnant, was the standard procedure. [Results] This procedure was performed successfully in all 33 patients. The mean operative time, mean blood loss were 202.1 min, 59.4 mL, respectively. Postoperative transient hypocalcemia occurred in 2 cases （0.6%）, transient hoarseness occurred in 1 cases （0.3%）, and no other complications were noted. 3 case experienced recurrent hyperthyroidism and 5 case experienced hypothyroidism during a mean follow-up period of 8.1 months. All patients were satisfied with the cosmetic result of the procedure. [Conclusions] Endoscopic thyroidectomy performed via axillo-breast approach is a technically feasible and safe procedure with excellent cosmetic results for patients with Graves＇ disease.