经胸乳晕入路腔镜手术精准治疗甲状腺微小癌65例临床分析

Endoscopic accurate treatment of thyroid microcarcinoma via breast areola approach:a clinical analysis of 65 cases

目的:探讨经胸乳晕入路腔镜精准治疗甲状腺微小癌的可行性。方法:回顾分析2013年3月至2016年5月65例经胸乳晕入路行腔镜甲状腺微小乳头状癌改良根治术患者的临床资料,结合手术经验,总结分析手术方法及手术安全性、有效性、难度盲点等。结果:1例患者合并桥本甲状腺炎中转开放手术,余者均顺利完成腔镜手术。手术时间平均(103.5±15.9)min,术中出血量平均(15±5)ml,术后引流量平均(150±30)ml。喉返神经损伤致声音嘶哑2例,其中1例术后1个月声音恢复,1例3个月后恢复,未出现永久损伤;3例出现暂时性低钙血症,均于住院期间恢复。随访患者均无颈部不适,B超复查均未提示肿瘤复发,2例提示淋巴结肿大;切口愈合良好,无瘢痕,美容效果明显。结论:经胸乳晕入路腔镜手术精准治疗甲状腺微小癌安全、可靠,具有术后并发症少、康复快、美容效果好的优势,可在临床推广应用。

Objective ： To investigate the feasibility of endoscopic accurate treatment of thyroid microcarcinoma via breast areola approach. Methods ： Retrospective analysis was made on the clinical data of 65 patients who underwent endoscopic modified radical op- eration for thyroid micro-papillary carcinoma via breast areola approach from Mar. 2013 to May 2016. Combining with surgical experi- ence, the method, safety, feasibility and difficulty of operation were summarized and analyzed. Results ： Among 65 patients of thyroid mi- crocarcinoma, only 1 patient with Hashimoto thyroiditis was converted to open surgery, the rest endoscopic operations were successfully completed. The operation time was （ 103.5 ± 15.9 ） min, intraoperative bleeding was （ 15 ±5 ） ml, postoperative drainage was （ 150 ± 30） ml. There were 2 cases of hoarseness caused by recurrent laryngeal nerve injury, one case recovered in one month after operation, and the other recovered after three months, no permanent damage occurred in any cases. Three patients suffered from temporary hypocal- cemia and recovered during hospitalization. No neck discomfort was reported during the follow-up, and no recurrence was found with B- uhrasonography except 2 cases with enlarged lymph nodes. Incision healed well without scar, and cosmetic effect was obvious. Conclu- sions ： Endoscopic transthoracic areola surgery is safe and reliable in the treatment of thyroid microcarcinoma with the advantages of few postoperative complications, rapid recovery and good cosmetic result, thus can be widely used in clinic.