Lombardi Celestino Pio, Raffaelli Marco, Princi Pietro, De Crea Carmela, Bellantone Rocco
Division of Endocrine Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy.
World J Surg. 2006 May;30(5):794-800; discussion 801. doi: 10.1007/s00268-005-0390-5.
We report on our series of patients selected for video-assisted thyroidectomy (VAT) over a 7-year period and discuss the results obtained.
Video-assisted thyroidectomy is a gasless procedure performed under endoscopic vision through a single 1.5-2.0-cm skin incision, using a technique very similar to conventional surgery. Eligibility criteria were these: thyroid nodules < 35 mm; thyroid volume < 30 ml; no previous conventional neck surgery. Small, low-risk, papillary thyroid carcinomas (PTC) were considered eligible.
A total of 473 VATs were attempted on 459 patients. Locoregional anesthesia was used in 15 patients. Conversion was necessary in 6 (difficult dissection in 1 case, large nodule size in 3, gross lymph node metastases in 2). Thyroid lobectomy was successfully performed in 110 cases, total thyroidectomy in 343, and completion thyroidectomy in 14. In 66 patients with carcinoma, central neck nodes were removed through the same access. Concomitant parathyroidectomy was performed in 14 patients. Pathology showed benign disease in 277 cases, PTC in 175, and medullary microcarcinoma in 1. Postoperative complications included 8 transient recurrent nerve palsies, 64 transient hypocalcemias, 3 definitive hypocalcemias, 1 postoperative hematoma, and 2 wound infections. Postoperative pain was minimal and the cosmetic result excellent. In patients with PTC no evidence of recurrent or residual disease was shown.
Indications for VAT are still limited (20% of patients who require thyroidectomy). Nonetheless, in selected patients, it seems a valid option for thyroidectomy and it could be considered even preferable to conventional surgery because of its significant advantages, especially in terms of cosmetic result.
我们报告了在7年时间里选择接受电视辅助甲状腺切除术（VAT）的一系列患者，并讨论所取得的结果。
电视辅助甲状腺切除术是一种无气腹手术，通过一个1.5 - 2.0厘米的皮肤切口在内镜视野下进行，采用与传统手术非常相似的技术。入选标准如下：甲状腺结节<35毫米；甲状腺体积<30毫升；既往未行传统颈部手术。小型、低风险的甲状腺乳头状癌（PTC）也被视为符合条件。
共对459例患者尝试进行了473次电视辅助甲状腺切除术。15例患者采用局部区域麻醉。6例需要中转手术（1例为解剖困难，3例为结节较大，2例为有明显淋巴结转移）。成功进行甲状腺叶切除术110例，全甲状腺切除术343例，再次甲状腺切除术14例。66例癌患者通过相同入路切除了中央区颈部淋巴结。14例患者同时进行了甲状旁腺切除术。病理显示277例为良性疾病，175例为PTC，1例为髓样微小癌。术后并发症包括8例短暂性喉返神经麻痹、64例短暂性低钙血症、3例永久性低钙血症、1例术后血肿和2例伤口感染。术后疼痛轻微，美容效果良好。PTC患者未显示复发或残留疾病的证据。
电视辅助甲状腺切除术的适应证仍然有限（占需要甲状腺切除术患者的20%）。尽管如此，在选定的患者中，它似乎是甲状腺切除术的一个有效选择，并且由于其显著优势，尤其是在美容效果方面，甚至可以被认为比传统手术更可取。
