腔镜甲状腺手术临床应用争议和共识

Controversy and consensus of endoscopic thyroidectomy

腔镜甲状腺切除术(ET)是甲状腺手术的新术式,分为腔镜辅助甲状腺切除术(VAT)和完全腔镜甲状腺切除术(TET)。与传统开放甲状腺手术(OTS)相比,颈部无瘢痕ET(SET)具有良好美容效果。近年器械及技术发展,ET的适应证从良性疾病拓展到部分乳头状癌,且淋巴结转移已不是禁忌证,手术适应证及禁忌证上仍有争议。ET应属于肿瘤整形外科范畴,获得美容效果的同时,必须坚守OTS同样的治疗原则。实践已经证明,ET手术技术日趋成熟,安全、可行;但要顺利完成手术,术者除需有娴熟的腔镜下手术操作技能,还要有丰富的OTS手术经验。因此,ET的学习曲线比OTS更长。

Endoscopic Thyroidectomy is a new procedure for thyroid disease, including video-assisted thyroidectomy （VAT） and scarless endoscopic thyroidectomy （SET）, Compared with the traditional open thyroid surgery （OTS）, it is characterized with cosmetic benefits. Due to recent developments in equipment and tec, hnology, ET indications expanded from benign disease to partial papillary carcinoma, and lymph node metastasis is not part of its eontraindications. But the indications and contraindications of ET remains controversial. We believe that it belongs to oncoplastic surgery and it must adhere to the same principles as OTS. The complications of ET have its own characteristics. Practice has proved that ET is safe and feasible. Consummate laparoscopic surgery skills and rich experience in OTS is needed to achived successful ET, which required a relatively long learning curve.