经口腔前庭腔镜NOTES手术治疗甲状腺良性病变:附6例报告

Natural orifice translumenal endoscopic(NOTES) surgery through oral vestibule for benign thyroid disease:a report of 6 cases

目的：探讨经口腔前庭腔镜NOTES手术治疗甲状腺良性疾病的可行性。方法：2013年10月—2014年9月,对6例甲状腺良性病变患者采用经口腔前庭入路腔镜甲状腺NOTES手术。甲状腺结节位于右叶3例,左叶3例,均为单发结节;囊性结节1例,实性结节4例,混合性1例;结节直径1～4 cm。术前诊断甲状腺腺瘤1例,结节性甲状腺肿5例。结果：6例患者均成功实施经口腔前庭腔镜甲状腺NOTES手术,平均手术时间122（100～150）min;平均术中出血30（10～40）m L。其中甲状腺部分切除5例,单侧甲状腺大部分切除1例,无1例中转开放手术。病理诊断甲状腺腺瘤1例,结节性甲状腺肿5例。术后无神经或甲状旁腺损伤等严重并发症;平均住院时间8.2（8～10）d;随访3～13个月无局部复发。结论：经口腔前庭腔镜NOTES手术治疗甲状腺良性疾病是可行的,且切口隐蔽,美容效果满意。

Objective：To evaluate the feasibility of natural oriifce translumenal endoscopic（NOTES） surgery through the oral vestibule for benign thyroid disease.Methods：From October 2013 to September 2014,6 patients with benign nodular thyroid disease underwent NOTES surgery through the oral vestibule.Three patients had a solitary right thyroid nodule,and 3 patients had a solitary left thyroid nodule; the nodule was cystic in one case,solid in 4 cases,and mixed in one case.The diameters of the nodules ranged from 1 to 4 cm.One patient was diagnosed as thyroid adenoma and 5 patients were diagnosed as nodular goiter before operation.Results：NOTES thyroidectomy through the oral vestibule was performed successfully in the 6 patients,with an average operative time of 122（100–150） min and average intraoperative blood loss of 30（10–40） mL.Of the patients,5 cases underwent unilateral partial thyroidectomy,one case underwent unilateral subtotal thyroidectomy,and none required open conversion.Postoperative pathological examination revealed thyroid adenoma in one case and nodular goiter in 5 cases.No severe complications such as nerve or parathyroid injury occurred after operation.The average length of hospital stay was 8.2（8–10） d,and there was no local recurrence during the follow-up period of 3 to 13 months.Conclusion：NOTES thyroidectomy through the oral vestibule for benign thyroid disease is feasible,and has a hidden incision and satisfactory cosmetic results.