Shimizu Kazuo, Kitagawa Wataru, Akasu Haruki, Hirai Kyoji, Tanaka Shigeo
Department of Surgery (II), Nippon Medical School, Tokyo, Japan.
Nihon Geka Gakkai Zasshi. 2002 Oct;103(10):708-12.
Endoscopic thyroid surgery has become a common procedure in recent years, mainly because of its cosmetic advantages. Generally two methods are used to obtain a working space: CO2 insufflation and anterior neck skin lifting. The incision sites for approaching the thyroid are the chest wall, mammary areolar area, axillary and submandibular area, in addition to the neck. Among the new operative devices, the ultrasonically activated scalpel has contributed to the development of endoscopic thyroid surgery. Based on our experience of more than 180 cases using our original endoscopic method, video-assisted neck surgery(the VANS method), we here report the clinical outcome and usefulness of the method. The operating time and blood loss in patients with 161 benign thyroid tumors were statistically compared between the small-tumor group (n = 138, < 5 cm) and the large-tumor group (n = 23, > or = 5 cm). More than 60% of the benign and 7.1% of the malignant thyroid tumors were operated on using the VANS method. Near or subtotal lobectomy was the most common procedure (64.4%) for benign tumors. Malignancy was defined as a papillary carcinoma < 1 cm in diameter. Total lobectomy with lymph node clearance was performed for all malignant cases. Although the operating time and blood loss were statistically greater in the large-tumor group than the small-tumor group, with increased experience it was possible to remove tumors of up to 7.4 cm safely. Our findings show that the VANS method is feasible, practical, and safe, and has great cosmetic benefits. However, it must be remembered that the intrinsic surgical goal of treatment should not be compromised in the pursuit of less-invasive surgery. Care must be taken to select appropriate patients carefully and to train surgeons sufficiently in the techniques required.
近年来，内镜甲状腺手术已成为一种常见的手术方式，主要因其具有美容优势。一般采用两种方法来获得操作空间：二氧化碳气腹和颈前皮肤提拉。除颈部外，接近甲状腺的切口部位还有胸壁、乳晕区、腋窝和颌下区。在新的手术器械中，超声刀推动了内镜甲状腺手术的发展。基于我们使用原创内镜方法——视频辅助颈部手术（VANS法）进行180多例手术的经验，我们在此报告该方法的临床结果及实用性。对161例良性甲状腺肿瘤患者，在小肿瘤组（n = 138，< 5 cm）和大肿瘤组（n = 23，≥ 5 cm）之间对手术时间和失血量进行了统计学比较。超过60%的良性甲状腺肿瘤和7.1%的恶性甲状腺肿瘤采用VANS法进行手术。近全叶切除术是良性肿瘤最常见的手术方式（64.4%）。恶性肿瘤定义为直径< 1 cm的乳头状癌。所有恶性病例均行全叶切除并清扫淋巴结。虽然大肿瘤组的手术时间和失血量在统计学上高于小肿瘤组，但随着经验的增加，安全切除直径达7.4 cm的肿瘤成为可能。我们的研究结果表明，VANS法可行、实用且安全，具有很大的美容优势。然而，必须记住，在追求微创手术时，不应损害治疗的内在手术目标。必须谨慎仔细地选择合适的患者，并让外科医生充分掌握所需技术。
