Suzuki Shinichi, Takenoshita Seiichi
Department Surgery II, Fukushima Medical University School of Medicine, Fukushima, Japan.
Nihon Geka Gakkai Zasshi. 2006 Mar;107(2):59-63.
Endoscopic surgery has been introduced in the field of thyroid disease. Endoscopic thyroid surgery is divided into complete endoscopic surgery using CO2 gas, which is approached from the axilla, mammary areola, and anterior chest; and video-assisted thyroid surgery without CO2 gas, approached from the neck or anterior chest under the clavicula through a small incision. Many thyroid tumors are benign, and cases of thyroid cancer are few. Only 7.9% of patients who underwent endoscopic thyroid surgery in the English and Japanese literature had papillary thyroid cancer. Most of these underwent video-assisted thyroidectomy without gas. The indications for endoscopic surgery in papillary thyroid cancer is microcancer or small tumor without lympnode metastasis before surgery. In follicular thyroid cancer, minimally invasive thyroid cancer of less than 5cm is recommended for endoscopic thyroid surgery. Furthermore, in medullary carcinoma with multiple endocrine neoplasia, prophylactic thyroidectomy can be performed using these endoscopic techniques. At present, it is still controversial whether endoscopic surgery should be performed to treat thyroid cancer.
内镜手术已被引入甲状腺疾病领域。内镜甲状腺手术分为使用二氧化碳气体的完全内镜手术，其手术入路为腋窝、乳晕和前胸；以及不使用二氧化碳气体的视频辅助甲状腺手术，通过颈部或锁骨下前胸的小切口入路。许多甲状腺肿瘤是良性的，甲状腺癌病例较少。在英文和日文文献中，接受内镜甲状腺手术的患者中只有7.9%患有乳头状甲状腺癌。其中大多数接受了无气视频辅助甲状腺切除术。乳头状甲状腺癌内镜手术的适应证为术前微小癌或无淋巴结转移的小肿瘤。对于滤泡状甲状腺癌，推荐对直径小于5cm的微创甲状腺癌进行内镜甲状腺手术。此外，对于伴有多内分泌腺瘤病的髓样癌，可使用这些内镜技术进行预防性甲状腺切除术。目前，对于是否应采用内镜手术治疗甲状腺癌仍存在争议。
