腔镜甲状腺手术发展与选择

Development and choice of endoscopic thyroid surgery

目的总结腔镜甲状腺手术发展历程并阐述各式入路的优点与缺点。方法检索国内外腔镜甲状腺手术的不同入路方式并予以综述。结果1996年Gagner首次尝试了内窥镜下甲状旁腺次全切除术,1997年Hüscher首次将腔镜技术改良并运用于甲状腺腺叶切除术。此后,腔镜甲状腺手术发展迅速,由颈部小切口手术如腔镜辅助下颈部小切口甲状腺切除等,到颈部无痕如胸乳入路、乳晕入路、腋窝入路、耳后入路、联合入路等,再到近几年的体表皮肤无痕如经自然腔道口腔入路。经完全腔镜手术使得切口瘢痕隐藏甚至消失,受到了全球甲状腺专科临床医生的关注并学习,患者的选择越来越宽泛、多样,各式入路都有各种不同的优点与缺点。结论各种腔镜手术入路有其优劣势以及适应证和禁忌证,应根据患者个体甲状腺肿块的位置差异以及对美观的要求度,选择最为合适的腔镜甲状腺入路方式,达到手术入路上的最优解。

Objective To summarize the development of endoscopic thyroid surgery and expound the advantages and disadvantages.Method Reviewed the domestic and foreign literatures on different ways of endoscopic thyroid surgery.Results Gagner tried accomplish subtotal parathyroidectomy with endoscope at the first time in 1996.And then,Hüscher improved the endoscope technology and applied on thyroidectomy in 1997.Henceforth,endoscopic thyroid surgery had developed rapidly,from small neck incision surgery,such as endoscopic assisted small neck incision thyroidectomy,to traceless neck surgery,such as thoraco mammary approach,areola approach,axillary approach,retroauricular approach,combined approach,etc.,to traceless body surface skin surgery in recent years,such as natural cavity oral approach.Completed endoscopic surgery makes the incision scar hide or even disappear,which had attracted the attention and learning of thyroid specialist clinicians all over the world.The choice of patients was more and more broad and diverse,and all kinds of approaches had different advantages and disadvantages.Conclusions The advantages,disadvantages,indications and contraindications of various endoscopic approaches are different.According to the location differences of individual thyroid masses and the requirements for aesthetics,the most appropriate endoscopic thyroid approach is selected to achieve the optimal solution of manual approach.