腔镜下甲状腺切除术的回顾与展望

Endoscopic thyroid surgery： the past, the present, and the future

甲状腺疾病患者多数为女性,传统手术可遗留明显的颈前可见瘢痕,患者在美容方面的要求催生了腔镜下甲状腺切除术并推动其不断发展.各种腔镜甲状腺技术的发展以最大限度地减少术后瘢痕的形成并促进术后的快速康复为目的,由此产生了两种截然不同的发展思路.一种致力于缩短手术切口长度、减少解剖范围,提供直接的、自然的手术径路;另一种则致力于开发颈外远距离入路,借助腔镜和（或）机器人技术,将颈部瘢痕隐藏在衣物可遮蔽之处.选择合适的患者,这些技术能实现治愈疾病和美容的双重目的.尽管腔镜下甲状腺切除术的适应证不断扩大,但在手术创伤及恶性肿瘤根治性方面一直存在争议.

Thyroid diseases are much more common in women than in men.The traditional open thyroidectomy brings almost patients significant visible scars in the anterior neck.The demand for cosmesis after surgery promotes the occurrence and development of endoscopic techniques.Various endoscopic techniques were designed to minimize the visible scar and promote the rehabilitation after surgery.In order to achieve these,two distinct ideas have developed.One is committed to shorten the length of surgical incision as much as possible.The other is to develop external cervical approaches,using endoscopy and（or） robotic assisted techniques,leaving the original visible neck scar in easily and well hidden area of the body.For strictly selected patients,these techniques achieve both therapeutic and cosmetic results.Although the indication of endoscopic thyroid surgery has been expanding constantly,the surgical trauma and the radical effect of malignant tumor are also controversial.