全乳晕入路腔镜甲状腺微小乳头状癌根治术:附23例报告

Analysis of endoscopic radical operation for papillary thyroid microcarcinoma via bilateral areolar approach in 23 cases

目的:探讨应用腔镜经全乳晕入路行甲状腺微小乳头状癌根治手术的经验及效果。方法:回顾性分析2015年1月—2017年1月23例行腔镜经全乳晕入路甲状腺微小乳头状癌根治术患者的临床资料。患者均为甲状腺单发结节,肿瘤直径均≤1.0 cm;均无颈部淋巴结转移;其中女18例,男5例,平均年龄37.13岁。结果:均成功实施腔镜甲状腺癌根治术,无中转开放手术,术后无因并发症二次手术者。平均手术时间为183.83(155~221)min,平均术后引流管留置时间2.17(2~3)d,术后平均住院时间为2.39(2~5)d。术后发生轻度饮水呛咳1例,1周内恢复正常;术后出现不同程度的皮下气肿6例,1周内均自行吸收。随访至今未发现肿瘤复发、淋巴结或远处转移病例。术后随访观察患者切口瘢痕小,美容效果好。结论:全乳晕入路腔镜甲状腺微小乳头状癌根治术是一种效果确切、安全可行的方法,且美容效果好。

Objective： To investigate the experience and efficacy of endoscopic radical operation via bilateral areolar approach in treatment of papillary thyroid microcarcinoma.Methods： The clinical data of 23 patients undergoing endoscopic radical operation for papillary thyroid microcarcinoma via bilateral areolar approach between January 2015 and January 2017 were analyzed retrospectively. All patients had a solitary thyroid nodule, with tumor size ≤1.0 cm. None of the patients had cervical lymph node metastasis. Of the patients, 18 cases were female and 5 cases were male, with an average age of 37.13 years.Results： Radical thyriodectomy was successfully performed in all the patients, without any open conversion.No reoperation due to complications was required. The average operative time was 183.83（155–221） min,time for postoperative drainage tube was 2.17（2–3） d, and length of postoperative hospital stay was 2.39（2–5） d,respectively. After surgery, mild choking when drinking fluids occurred in one case, which recovered within one week; varying degrees of subcutaneous emphysema occurred in 6 cases and, in all the cases, it was spontaneously absorbed within one week. No tumor recurrence, or lymph node and distal metastasis were found on regular follow-up to date. All patients showed minimal scar and good cosmetic results in postoperative followup observation.Conclusion： Endoscopic radical operation for papillary thyroid microcarcinoma via bilateral areolar approach is an effective, safe and feasible procedure, with favorable cosmetic results.