三维可视化模型经乳晕单通道腔镜切除甲状腺大结节(附33例报告)

Virtual 3D modeling in trans-areola single-site endoscopic thyroidectomy for large nodular goiter:a report of 33 cases

目的:探讨三维可视化模型用于经乳晕单通道腔镜甲状腺切除术(trans-areola single-site endoscopic thyroidectomy,TASSET)治疗甲状腺大结节(长径≥3 cm)。方法:回顾性分析2017年6月至2019年1月33例行TASSET的甲状腺大结节病人临床资料。所有病人术前行CT和超声检查完成甲状腺结节定位,并运用数字化技术构建三维可视化模型,进行甲状腺结节定位与手术规划。统计分析手术病人结节位置、结节大小、手术时间、术后病理检查结果、并发症发生等临床资料。术后随访治疗效果。结果:33例病人均依据术前手术规划方案顺利完成TASSET,无中转开放手术。左侧腺叶结节19例,右侧腺叶结节14例。平均结节长径(37.3±7.2)mm,手术时间(107.6±23.6)min。术后病理检查结果示结节性甲状腺肿18例,滤泡性腺瘤8例,Hürthle细胞腺瘤4例,淋巴细胞性甲状腺炎2例,甲状腺毒性腺瘤1例。所有病人无术后并发症发生。术后随访7~26个月,病人目前均无腺体残留或复发征象。结论:术前运用三维数字化技术构建可视化模型进行结节定位、手术规划,能降低手术风险,提高手术的安全性和有效性,对TASSET手术治疗甲状腺大结节具有临床意义。

Objective To evaluate virtual 3-dimensional(3D)modeling in treatment of large nodular goiter(length≥3 cm)via trans-areola single-site endoscopic thyroidectomy(TASSET).Methods Clinical data with 33 patients who received TASSET for large nodular goiter from June 2017 to January 2019 were investigated retrospectively.All patients underwent preoperative localization by CT and ultrasonography.Digital technique was utilized to build the virtual 3D modeling for nodular localization and digital surgical planning.Clinical data including the location and size of nodules,operative time,pathological results,and complications were analyzed.Patients were followed-up postoperatively for therapeutic outcome.Results All patients underwent TASSET successfully followed the preoperative digital surgery planning without conversion to open surgery.There were 19 cases with left thyroid nodules and 14 cases with right thyroid nodules.Mean length of nodule was(37.3±7.2)mm with operative time(107.6±23.6)min.Pathological examination showed 18 cases of nodular goiter,8 cases of follicular adenoma,4 cases of Hürthle cell adenoma,2 cases of lymphocytic thyroiditis,and 1 case of toxic thyroid adenoma.No postoperative complication was observed.Patients were followed-up during 7 to 26 months without residual thyroid or recurrence.Conclusions Preoperative application of 3D digital technique to build visualization model for nodule localization and surgery planning could reduce operative risk and improve the safety and effec-tiveness of TASSET in treatment of large nodular goiter.