经胸乳入路内镜手术治疗甲状腺乳头状癌85例临床分析

Endoscopic thyroidectomy via anterior chest and breast for the treatment of papillary thyroid carcinoma

目的探讨经胸乳入路内镜手术治疗甲状腺乳头状癌的可行性、有效性及安全性。方法回顾性分析2006年3月至2010年3月问浙江大学医学院附属第二医院内镜手术治疗的85例甲状腺乳头状癌患者的临床资料。结果84例患者手术成功，平均手术时间113．3min。84例均行中央区清扫，其中12例怀疑颈侧区淋巴结转移者加行患侧颈侧区清扫。平均清扫淋巴结数目在中央区为6．5个，在颈侧区为19．2个。6例（7．14％，6／84）出现术后暂时性声音嘶哑，4例（4．76％，4／84）术后发生一过性低血钙症状。随访9～57个月，B超和ECT提示患侧无残留腺体，局部无复发，颈部外观良好，所有患者对手术效果均满意。结论内镜甲状腺手术治疗严格选择的甲状腺乳头状癌是安全可行的，但其远期效果还有待长期随访观察。

Objective To evaluate the feasibility and safety of endoscopic thyroidectomy via anterior chest and breast for the treatment of patients with papillary thyroid carcinoma （ PTC ）. Methods Endoscopic thyroidectomy was performed in 85 PTC patients between March 2006 and March 2010. Diagnosis was based on intraoprative frozen section. There were 83 females and 2 males, age averaged at 36. 3 years. Sixty three of 85 cases were diagnosed preoperatively as thyroid carcinoma and US revealed ipsilateral cervical lymph node enlargement suspective of metastasis in 12 cases. Endoscopic thyr0idectomy plus selective neck dissection was performed. Results This procedure was carried out successfully in 84 patients. There were 51 cases of papillary thyroid microcarcinomas（ 〈 1.0 cm）, 28 cases between 1.0 cm and 〈 2.0 cm, and 5 cases with the diameter between 2. 0 cm and 3.0 cm. Total thyroidectomy, ispilateral lebectomy and ispilateral lebectomy plus contralateral subtotal lobetomy were performed in 4, 6, 74 cases, respectively. Central compartment dissection was performed in all of the 84 cases and ipsilateral neck dissection was also performed in 12 cases that were suspected metastatic lateral neck lymph nodes. The mean operative time was （ 113.3± 46. 5） minutes. No significant blood loss occurred. The mean number of lymph nodes yield in the central compartment and lateral compartment were 6. 5 （range 2 to 14） and 19. 2 （range 9 to 26 ）, respectively. Forty-four cases （44/84, 52. 4% ） had metastatic lymph nodes in central compartment, while 11 cases（ 11/12,91.7% ） in lateral compartment. Six patients （6/84,7.14%） had transient vocal cord palsy and recovered after 1 -2 months. Postoperative transient hypocalcaemia occurred in 4 cases （4. 8% ）, and there were no other major complications. The average postoperative hospital stay was 3.7 days （ range 3 to 6）. No evidence of residual or recurrent disease was found at follow-up. The cosmetic results of this procedure were excellent. Conclusions The anterior chest and breast approach of endoscopic thyroidectomy is feasible and safe and cosmetic worthwhile for selected cases of PTC.