腔镜技术在甲状腺微小乳头状癌治疗中应用

Endoscopic thyroidectomy for thyroid microcarcinoma

经过20年的发展,腔镜甲状腺切除术适应证已经扩展至分化型甲状腺癌,尤其是甲状腺微小乳头状癌(PTMC)。术前评估是关键,评估的重点是原发肿瘤的位置以及转移淋巴结的大小、位置;腔镜PTMC手术关键是如何保护喉返神经(RLN)及甲状旁腺的功能。对于初学者,或遇到喉不返神经,或二次手术的时候,术中神经监测有明显的优势。对于PTMC病人,近全甲状腺切除术代替全切除术是防止甲状旁腺永久性损伤的有效术式。目前,对于PTMC行腔镜甲状腺手术治疗,在手术入路选择及淋巴结清扫范围等方面还存在争议。

With twenty years＇ development, scarless endoscopic thyroidectomy （SET） indications have expanded from benign disease to differentiated thyroid carcinoma （DTC） , especially papillary thyroid microcarcinoma （PTMC）. It is very important for preoperative evaluation, which emphases are location and size of tumor and metastatic lymph nodes. The key surgical procedure is protection of RLN and parathyroid glands. For beginners, reoperation and non-RLN, intraoperative neuromonitoring （IONM） has obviously advantage. For PTMC, near total thyroidectomy is recommended to avoid permanent hypoparathyroidism, instead of total thyroidectomy. At present, in endoscopic surgery of PTMC, the endoscopic approach and the scope lymph node dissection remain controversial.