Objective:Minimally invasive video-assisted thyroidectomy(MIVAT)is among the most common alternatives to conventional open thyroidectomy.Previous reports have shown it to be safe and effective in patients without neck...Objective:Minimally invasive video-assisted thyroidectomy(MIVAT)is among the most common alternatives to conventional open thyroidectomy.Previous reports have shown it to be safe and effective in patients without neck surgery history.However,this contraindication has been called into question in more recent small series.This study aims to evaluate the efficacy and safety of MIVAT in patients with prior neck surgery.Methods:We retrospectively reviewed the data of 178 patients who underwent completion thyroidectomy in the Department of Otolaryngology-Head and Neck Surgery at Loma Linda University Medical Center between July 2004 and July 2017.Patients were divided into MIVAT group and Conventional group based on method of surgery,and analysis with two sample tests of proportions was carried out as appropriate.Results:Patients in MIVAT group had significantly shorter operative time(74.1±26.4 min vs.99.0±49.3 min,p<0.001),less estimated blood loss(19.5±15.0 mL vs.39.0±65.9 mL,p¼0.002),smaller incision size(3.5±1.1 cm vs.6.2±2.2 cm,p<0.001),and a lighter thyroid weight(7.5±5.2 g vs.20.5±31.1 g,p<0.001).The average length of stay was a half day longer,and post-operative admission was higher(78.8%vs.51.7%,p¼0.005)in MIVAT group,while most was for routine 23-hour observation(63.6%vs.35.9%,p¼0.009).There were no differences in complications.Conclusion:MIVAT is feasible for re-operative patients with equivalent or superior outcomes to those of conventional thyroidectomy,and no significant difference in the incidences of common postoperative complications.展开更多
Background Minimally invasive video-assisted thyroidectomy （MIVAT） has received increasing attention for malignant thyroid diseases. The aim of this study was to compare the outcomes of MIVAT with conventional open ...Background Minimally invasive video-assisted thyroidectomy （MIVAT） has received increasing attention for malignant thyroid diseases. The aim of this study was to compare the outcomes of MIVAT with conventional open thyroidectomy （CT） for papillary thyroid microcarcinoma （PTMC）. Methods Thirty-one patients were treated with MIVAT and 37 with CT. Their pathological characteristics, surgical complications, 5-year postoperative thyroglobulin （TG） and ultrasonic results were followed up. Results All the patients took levothyroxine for suppressing thyroid stimulating hormone （TSH） after surgery, and were followed up with measurement of serum TG and neck ultrasonography at intervals of 6 or 12 months. There was no statistically significant difference between the CT and MIVAT groups for sex ratio, operation time, positive lymph nodes, complications and prognosis, but the MIVAT group had better cosmetic results. Conclusions MIVAT did not differ significantly from CT for PTMC after 5 years follow-up, but it did have better cosmetic results. MIVAT is a safe and valid surgical technique for selected cases.展开更多
Approximately 25%of goiters extend to the substernal area,and most of them can be removed through a cervical incision.Goiters that extend into the posterior mediastinum are very rare,and resection usually requires tho...Approximately 25%of goiters extend to the substernal area,and most of them can be removed through a cervical incision.Goiters that extend into the posterior mediastinum are very rare,and resection usually requires thoracotomy.In recent years,there have been several reports of resection of substernal goiters by minimally invasive surgery.Here,we present a 75-year-old female with a giant substernal goiter who successfully underwent resection of the goiter extending to the posterior mediastinum using low cervical incision combined with video-assisted thoracoscopy.展开更多
目的：探讨整块与分块切除在腔镜辅助甲状腺微小乳头状癌手术中的应用效果。方法回顾性分析2013年2月～2014年2月北京安贞医院腔镜辅助手术中快速冰冻病理证实甲状腺微小乳头状癌患者62例资料，前24例先行患侧腺叶、峡部切除，继而在纳...目的：探讨整块与分块切除在腔镜辅助甲状腺微小乳头状癌手术中的应用效果。方法回顾性分析2013年2月～2014年2月北京安贞医院腔镜辅助手术中快速冰冻病理证实甲状腺微小乳头状癌患者62例资料，前24例先行患侧腺叶、峡部切除，继而在纳米碳示踪下行中央区淋巴结分块清扫（分块切除组），后38例将患侧腺叶、峡部、中央区淋巴脂肪组织连续整块切除一次完成（整块切除组）。对2组手术时间、术中出血量、中央区淋巴结清扫数量、术后并发症情况进行比较。结果2组手术均顺利完成，无中转开放手术。整块切除组较分块切除组手术时间长[（86．1±10．0）min vs ．（73．5±8．9） min，t＝4．997，P＝0．000]，2组术中出血量差异无显著性（P＞0．05），而中央区淋巴结清扫数量整块切除组明显多于分块切除组[（8．2±1．6）枚vs．（6．1±1．5）枚，t＝5．131，P＝0．000]。2组均无永久性喉返神经损伤及低钙血症。术后暂时性声音嘶哑整块切除组3例，分块切除组4例，总发生率为11．3％（7／62），2组间差异无显著性（χ2＝0．424，P＝0．515），未予特殊处理，均于术后8周内恢复正常。术后随访5～17个月，平均10个月，均无局部种植、复发和远处转移。结论整块切除较分块切除更符合无瘤原则，在腔镜辅助甲状腺微小乳头状癌手术中可以得到安全的应用。展开更多
目的：探讨腔镜技术用于甲状腺手术获得美容效果的临床应用价值及其安全性和微创性。方法：2006年5月至2008年8月，行甲状腺手术93例，其中腔镜甲状腺手术38例，传统开放甲状腺手术55例。比较两种术式的手术时间、术中失血量、切口美容...目的：探讨腔镜技术用于甲状腺手术获得美容效果的临床应用价值及其安全性和微创性。方法：2006年5月至2008年8月，行甲状腺手术93例，其中腔镜甲状腺手术38例，传统开放甲状腺手术55例。比较两种术式的手术时间、术中失血量、切口美容评分、术后住院时间、住院费用、手术并发症和复发率。结果：两组手术均获成功，无出血、声嘶、低血钙等并发症。腔镜组与传统开放组相比，失血量少（14±10ml vs 19±15ml，t=-2．270，P=0．023），切口美容满意度高（VAS评分7．0±1．5 vs 2．0±1．4，t=24．549，P=0．000），术后颈前无手术疤痕，无皮肤色泽改变，但手术时间长（70±20min vs 60±30min。t=2．260，P=0．022），住院费用高（5843．5±897元vs4859．4±683元，t=4．463，P=0．000）。发生切口积液腔镜手术1例，开放组3例。随访2～30个月，平均14个月，复发2例，其中腔镜组0例，传统组2例。结论：腔镜甲状腺手术与传统甲状腺手术相比，腔镜甲状腺手术可获得理想的美容效果，手术安全、恢复快，有着传统开放甲状腺手术不可比拟的优点，是治疗良性甲状腺疾病的理想手术方法。展开更多
文摘Objective:Minimally invasive video-assisted thyroidectomy(MIVAT)is among the most common alternatives to conventional open thyroidectomy.Previous reports have shown it to be safe and effective in patients without neck surgery history.However,this contraindication has been called into question in more recent small series.This study aims to evaluate the efficacy and safety of MIVAT in patients with prior neck surgery.Methods:We retrospectively reviewed the data of 178 patients who underwent completion thyroidectomy in the Department of Otolaryngology-Head and Neck Surgery at Loma Linda University Medical Center between July 2004 and July 2017.Patients were divided into MIVAT group and Conventional group based on method of surgery,and analysis with two sample tests of proportions was carried out as appropriate.Results:Patients in MIVAT group had significantly shorter operative time(74.1±26.4 min vs.99.0±49.3 min,p<0.001),less estimated blood loss(19.5±15.0 mL vs.39.0±65.9 mL,p¼0.002),smaller incision size(3.5±1.1 cm vs.6.2±2.2 cm,p<0.001),and a lighter thyroid weight(7.5±5.2 g vs.20.5±31.1 g,p<0.001).The average length of stay was a half day longer,and post-operative admission was higher(78.8%vs.51.7%,p¼0.005)in MIVAT group,while most was for routine 23-hour observation(63.6%vs.35.9%,p¼0.009).There were no differences in complications.Conclusion:MIVAT is feasible for re-operative patients with equivalent or superior outcomes to those of conventional thyroidectomy,and no significant difference in the incidences of common postoperative complications.
文摘Background Minimally invasive video-assisted thyroidectomy （MIVAT） has received increasing attention for malignant thyroid diseases. The aim of this study was to compare the outcomes of MIVAT with conventional open thyroidectomy （CT） for papillary thyroid microcarcinoma （PTMC）. Methods Thirty-one patients were treated with MIVAT and 37 with CT. Their pathological characteristics, surgical complications, 5-year postoperative thyroglobulin （TG） and ultrasonic results were followed up. Results All the patients took levothyroxine for suppressing thyroid stimulating hormone （TSH） after surgery, and were followed up with measurement of serum TG and neck ultrasonography at intervals of 6 or 12 months. There was no statistically significant difference between the CT and MIVAT groups for sex ratio, operation time, positive lymph nodes, complications and prognosis, but the MIVAT group had better cosmetic results. Conclusions MIVAT did not differ significantly from CT for PTMC after 5 years follow-up, but it did have better cosmetic results. MIVAT is a safe and valid surgical technique for selected cases.
基金supported by the Fundamental Research Funds for the Central Universities(2021FZZX005-21).
文摘Approximately 25%of goiters extend to the substernal area,and most of them can be removed through a cervical incision.Goiters that extend into the posterior mediastinum are very rare,and resection usually requires thoracotomy.In recent years,there have been several reports of resection of substernal goiters by minimally invasive surgery.Here,we present a 75-year-old female with a giant substernal goiter who successfully underwent resection of the goiter extending to the posterior mediastinum using low cervical incision combined with video-assisted thoracoscopy.
文摘目的：探讨整块与分块切除在腔镜辅助甲状腺微小乳头状癌手术中的应用效果。方法回顾性分析2013年2月～2014年2月北京安贞医院腔镜辅助手术中快速冰冻病理证实甲状腺微小乳头状癌患者62例资料，前24例先行患侧腺叶、峡部切除，继而在纳米碳示踪下行中央区淋巴结分块清扫（分块切除组），后38例将患侧腺叶、峡部、中央区淋巴脂肪组织连续整块切除一次完成（整块切除组）。对2组手术时间、术中出血量、中央区淋巴结清扫数量、术后并发症情况进行比较。结果2组手术均顺利完成，无中转开放手术。整块切除组较分块切除组手术时间长[（86．1±10．0）min vs ．（73．5±8．9） min，t＝4．997，P＝0．000]，2组术中出血量差异无显著性（P＞0．05），而中央区淋巴结清扫数量整块切除组明显多于分块切除组[（8．2±1．6）枚vs．（6．1±1．5）枚，t＝5．131，P＝0．000]。2组均无永久性喉返神经损伤及低钙血症。术后暂时性声音嘶哑整块切除组3例，分块切除组4例，总发生率为11．3％（7／62），2组间差异无显著性（χ2＝0．424，P＝0．515），未予特殊处理，均于术后8周内恢复正常。术后随访5～17个月，平均10个月，均无局部种植、复发和远处转移。结论整块切除较分块切除更符合无瘤原则，在腔镜辅助甲状腺微小乳头状癌手术中可以得到安全的应用。
文摘目的：探讨腔镜技术用于甲状腺手术获得美容效果的临床应用价值及其安全性和微创性。方法：2006年5月至2008年8月，行甲状腺手术93例，其中腔镜甲状腺手术38例，传统开放甲状腺手术55例。比较两种术式的手术时间、术中失血量、切口美容评分、术后住院时间、住院费用、手术并发症和复发率。结果：两组手术均获成功，无出血、声嘶、低血钙等并发症。腔镜组与传统开放组相比，失血量少（14±10ml vs 19±15ml，t=-2．270，P=0．023），切口美容满意度高（VAS评分7．0±1．5 vs 2．0±1．4，t=24．549，P=0．000），术后颈前无手术疤痕，无皮肤色泽改变，但手术时间长（70±20min vs 60±30min。t=2．260，P=0．022），住院费用高（5843．5±897元vs4859．4±683元，t=4．463，P=0．000）。发生切口积液腔镜手术1例，开放组3例。随访2～30个月，平均14个月，复发2例，其中腔镜组0例，传统组2例。结论：腔镜甲状腺手术与传统甲状腺手术相比，腔镜甲状腺手术可获得理想的美容效果，手术安全、恢复快，有着传统开放甲状腺手术不可比拟的优点，是治疗良性甲状腺疾病的理想手术方法。
