改良Miccoli腔镜辅助甲状腺微小癌手术临床分析

The Clinic-evaluation of Endoscopic-assisted Surgical Management of Thyroid Microcarcinoma

目的探讨改良Miccoli腔镜手术治疗甲状腺微小癌（thyroid microcarcinoma，TAT）的可行性、有效性及安全性。方法2010年3月～2011年9月，行改良Miccoli腔镜下甲状腺手术12例，术中冰冻切片检查报告TMC6例，在腔镜下行患侧甲状腺腺叶全切除＋峡部切除＋Ⅵ区淋巴结清扫术。结果6例手术时间90~160min，平均120min，肿瘤最大径0．2～1．0cm，平均0．56Gm。1例（8．33％）术后一过性喉返神经损伤导致暂时性声音嘶哑，术后1~2个月恢复。无术后出血、皮下气肿、饮水呛咳以及低血钙。术后病理报告均为TAT。Ⅵ区淋巴结清扫数目2～8个．平均4．6个，其中2例（33．3％）淋巴结有癌转移。随访时间2～18个月，平均12个月，B超和颈部增强CT提示患侧甲状腺无残留腺体，局部无复发。结论改良Miccoli腔镜甲状腺手术治疗TAT是安全可行的．可作为TAT手术治疗的一种选择。

Objective To evaluate the feasibility,efficacy and safety＇of endoscopic-assisted thyroidectomy in the treatment of thyroid microcarcinoma （TMC）. Methods endoscopic-assisted thyroidectomy was performed on totally 12 patients,with thyroid diseases between March 2010 and September 2011 . Among these patients, 6 cases were diagnosed with TMC by intraoperative frozen section examination and thus were treated with lobotomy plus central compartment dissecti on and contral ateral subtotal lobatomy by using endoscopic-assisted. Results The mean operation time of the 6cases was 120 min（ rang, 90 - 160 min） , and the maximum diameter of the tumors ranged 0.2 cm to 1.0 cm, with a mean of 0 . 56 cm. One of the cases （8.33% ） suffered fr om temporary hoarseness after the operation due to transient recurrent laryngeal nerve injury and then were cureds pontaneously in 1-2 months.No episodes of postoperative bleeding, subcutaneous emphysema, wet cough or hypocalcaemia occurred in this series of patients.The TMC was confirmed by post operative pathological examination in all the cases . During the operati on, a mean of 4.6 （2 to 8） lymphnodes in the VI area were dissected,and lymph node metastasis were demonstrated in 2 cases （33 .3% ） . The patients were followed up for 2- 18 months （mean： 12 months ） , during which ultras onography and CT showed neither residual thyroid tissue nor recurrence in the surgical area. Conclusion endoscopic-assisted thyroidectomy is safe and feasible for TMC：.