胸乳入路腔镜甲状腺良性肿瘤手术适应证的探讨

Breast approach endoscopic surgery in treating thyroid benign tumor and its clinical application

目的探讨胸乳入路腔镜手术应用于甲状腺良性肿瘤的适应证及安全性。方法回顾性分析行胸乳入路腔镜手术治疗甲状腺单发良性肿瘤结节≤6 cm患者105例,按结节大小分为两组,其中小结节组(结节≤3 cm)46例,大结节组(3 cm<结节≤6 cm)59例。分析比较两组手术并发症及手术中转率和复发率。结果小结节组46例顺利完成手术;大结节组有2例因术中出血中转开放手术。两组手术并发症总发生率大结节组高于小结节组(P<0.05)。术后随访6～54个月,两组患者均无复发及甲状腺功能低下。结论胸乳入路腔镜手术是治疗甲状腺良性肿瘤的有效方法,但结节较大时手术安全性降低,且可能中转开放手术。故对结节较大者应持慎重态度,临床医生应严格把握手术适应证。

Objective To discuss the indications and safety of breast approach endoscopic surgery in the treatment of thyroid benign tumor. Methods One hundred and five patients who received breast approach endoscopic surgery for benign solitary thyroid nodules were retrospectively analyzed. According to the size of nodules, the patients were divided into two small nodule group （ n = 46, nodules ≤3 cm ） and large nodule group （ n = 59, 3 cm 〈 nodules ≤6 cm）. Surgical complications, operative conversion rate and recurrence rate were compared between two groups. Results Forty - six patients in small nodule group successfully completed surgery. Conversion to open surgery occurred in 2 patients in large nodule group because of bleeding. Complication rate in large nodule group was higher than that in small nodule group （ P 〈0.05）. No recurrence and hypothyroidism was observed during 6 - 54 months postoperative follow - up in both groups. Conclusion Breast approach laparoscopic surgery is an effective method for the treatment of thyroid benign tumor; however, it may not safe and need conversion to open surgery for large nodules. Operation mode and indications should be strictly controlled.