改良Miccoli术式腔镜双侧甲状腺癌根治术的应用体会

Modified Miccoli endoscopic radical resection of bilateral thyroid carcinoma

目的:探讨改良Miccoli术式腔镜双侧甲状腺癌根治术的手术方法及疗效。方法:回顾分析2017年1月至2021年12月为24例患者行改良Miccoli腔镜双侧甲状腺癌根治术的临床资料,观察六区淋巴结清扫数量及癌转移率、切口长度、手术时间、术中出血量、住院时间;并统计术后大出血、声音嘶哑、呛咳、手足抽搐等并发症发生率。结果:六区共清扫淋巴结242枚,平均(8.9±1.1)枚,其中淋巴结癌转移13例,转移率54.2%。切口长度平均(3.2±1.3)cm,手术时间平均(145.9±15.1)min,术中出血量(15.5±2.5)mL,平均住院(3.9±1.1)d,短暂性声音嘶哑3例,术后1个月内均恢复正常发音,一过性手足麻木3例,无呛咳、术后大出血、切口感染发生。结论:改良Miccoli腔镜双侧甲状腺癌根治术是安全、有效的,对神经、甲状旁腺的辨识与保护具有较好的帮助,对六区淋巴结清扫方便、有效。建立稳定的操作空间及相关专科手术设备是保证手术成功的前提。

Objective:To investigate the operation procedure and therapeutic effect of modified Miccoli endoscopic radical resection of bilateral thyroid carcinoma.Methods:The clinical data of 24 patients who underwent modified Miccoli endoscopic radical resection of bilateral thyroid carcinoma from Jan.2017 to Dec.2021 were retrospectively analyzed.The number of lymph node dissected in the six areas,the rate of cancer metastasis,length of the incision,operation time,intraoperative blood loss,hospital stay and some operation complications such as postoperative hemorrhage,hoarseness,choking and tetany were observed and counted.Results:A total of 242 lymph nodes were dissected in the six zones,with an average of(8.9±1.1)lymph nodes per case.There were 13 cases of lymph node metastasis,with a metastasis rate of 54.2%.The average incision length was(3.2±1.3)cm,the operation time was(145.9±15.1)min,the intraoperative blood loss was(15.5±2.5)mL,and the hospital stay was(3.9±1.1)d.There were 3 cases of transient hoarseness,and the vocalization returned to normal within one month after surgery;there were 3 cases of transient hand-foot numbness,and no choking,postoperative massive bleeding or incision infection occurred.Conclusions:The modified Miccoli endoscopic radical resection of bilateral thyroid carcinoma is safe and effective.It is helpful for the identification and protection of nerve and parathyroid gland.It is convenient and effective for the dissection of six-zone lymph nodes.The establishment of a stable operating space and the use of relevant specialized surgical equipment are the prerequisites to ensure the success of the operation.