Terris David J, Gourin Christine G, Chin Edward
Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta, GA 30912, USA.
Laryngoscope. 2006 Mar;116(3):350-6. doi: 10.1097/01.mlg.0000191462.58630.e4.
Minimal access surgery in the thyroid compartment has evolved considerably over the past 10 years and now takes many forms. We advocate at least two distinct approaches, depending on the disease process and multiple patient factors. The technical aspects are explored in depth with liberal use of videographic demonstration.
The authors conducted a comparison of two distinct surgical techniques with photographic and videographic documentation of two distinct minimal access approaches to the thyroid compartment termed minimally invasive thyroidectomy (MITh) and minimally invasive video-assisted thyroidectomy (MIVAT). Both historic and previously unpublished data (age, gender, pathology, incision length, and complications) are systematically analyzed.
Patients who underwent minimally invasive thyroidectomy (n = 31) had a mean age of 39.4 +/- 10.7 years; seven were male and 24 were female. The most common diagnosis was follicular or Hürthle cell adenoma (29%), followed by papillary or follicular cancer (26%). The mean incision length was 4.9 +/- 1.0 cm. One patient developed a hypertrophic scar and one patient developed thrombophlebitis of the anterior jugular vein. There were 14 patients in the MIVAT group with a mean age of 43.7 +/- 11.4 years; one was male and 13 were female. The majority of patients had follicular adenoma (42.9%) or papillary carcinoma (21.4%) as their primary diagnosis. The mean incision length was 25 +/- 4.3 mm (range, 20-30 mm), and there were no complications.
Two distinct approaches to minimal access thyroid surgery are now available. The choice of approach depends on a number of patient and disease factors. Careful patient selection will result in continued safe and satisfactory performance of minimally invasive thyroid surgery.
在过去10年里，甲状腺区域的微创手术有了很大发展，现在有多种形式。根据疾病过程和多个患者因素，我们提倡至少两种不同的方法。本文通过大量使用视频演示深入探讨了技术方面的问题。
作者对两种不同的手术技术进行了比较，并用照片和视频记录了甲状腺区域两种不同的微创方法，即微创甲状腺切除术（MITh）和微创视频辅助甲状腺切除术（MIVAT）。对历史数据和以前未发表的数据（年龄、性别、病理、切口长度和并发症）进行了系统分析。
接受微创甲状腺切除术的患者（n = 31）平均年龄为39.4±10.7岁；7例为男性，24例为女性。最常见的诊断是滤泡性腺瘤或许特莱细胞腺瘤（29%），其次是乳头状癌或滤泡状癌（26%）。平均切口长度为4.9±1.0 cm。1例患者出现增生性瘢痕，1例患者出现颈前静脉血栓形成。MIVAT组有14例患者，平均年龄为43.7±11.4岁；1例为男性，13例为女性。大多数患者的主要诊断为滤泡性腺瘤（42.9%）或乳头状癌（21.4%）。平均切口长度为25±4.3 mm（范围20 - 30 mm），且无并发症。
现在有两种不同的微创甲状腺手术方法。手术方法的选择取决于多种患者和疾病因素。仔细选择患者将使微创甲状腺手术持续安全且令人满意地进行。
