Chung Yoo Seung, Choe Jun-Ho, Kang Kyung-Ho, Kim Seok Won, Chung Ki-Wook, Park Kyoung Sik, Han Wonshik, Noh Dong-Young, Oh Seung Keun, Youn Yeo-Kyu
Department of Surgery, Seoul National University College of Medicine, Chongno-Gu, Seoul, Korea.
World J Surg. 2007 Dec;31(12):2302-6; discussion 2307-8. doi: 10.1007/s00268-007-9117-0.
Endoscopic techniques have recently been applied to thyroid surgery. We developed the bilateral axillo-breast (BAB) approach for total thyroidectomy. The aims of this study were to evaluate the completeness of this approach for total thyroidectomy and to compare complications between endoscopic thyroidectomy and conventional open thyroidectomy.
We analyzed 198 patients who underwent open thyroidectomy and 103 patients who underwent endoscopic thyroidectomy for papillary thyroid microcarcinoma between January 2003 and June 2006 at Seoul National University Hospital. The postoperative thyroglobulin (TG) level was used to assess the completeness of the two methods. Complications such as hypocalcemia or vocal cord palsy were also evaluated.
The mean hospitalization period was 3.18 days following open thyroidectomy and 3.04 days after endoscopic thyroidectomy. The 3-month postoperative TG levels were <1.0 ng/ml in 90.4% of patients after open total thyroidectomy and in 88.9% following endoscopic total thyroidectomy. Transient hypocalcemia occurred in 17.7% and 25.2% of patients, respectively. Permanent hypocalcemia occurred in 4.5% and 1.0% of patients, respectively. Permanent vocal cord palsy frequencies were 0.5% and 0%, respectively. There were no significant differences in postoperative TG levels, hypocalcemia, or permanent vocal cord palsy. Transient vocal cord palsy occurred in 2.5% of patients after open thyroidectomy and in 25.2% after endoscopic thyroidectomy (p < 0.0001), but it disappeared within 3 months. Cosmetic results were excellent after endoscopic thyroidectomy.
The bilateral axillo-breast (BAB) approach for endoscopic thyroidectomy shows insignificant postoperative complications, except transient vocal cord palsy, as well as good cosmetic results. It is also a feasible method for total thyroidectomy. Therefore, the BAB approach for endoscopic total thyroidectomy can be the surgical treatment of choice for selected cases of thyroid cancer.
内镜技术最近已应用于甲状腺手术。我们开发了双侧腋窝-乳房（BAB）入路用于全甲状腺切除术。本研究的目的是评估这种全甲状腺切除术入路的彻底性，并比较内镜甲状腺切除术与传统开放性甲状腺切除术之间的并发症。
我们分析了2003年1月至2006年6月在首尔国立大学医院接受开放性甲状腺切除术的198例患者和接受内镜甲状腺切除术的103例甲状腺微小乳头状癌患者。术后甲状腺球蛋白（TG）水平用于评估两种方法的彻底性。还评估了低钙血症或声带麻痹等并发症。
开放性甲状腺切除术后平均住院时间为3.18天，内镜甲状腺切除术后为3.04天。开放性全甲状腺切除术后90.4%的患者以及内镜全甲状腺切除术后88.9%的患者术后3个月TG水平<1.0 ng/ml。分别有17.7%和25.2%的患者发生短暂性低钙血症。分别有4.5%和1.0%的患者发生永久性低钙血症。永久性声带麻痹发生率分别为0.5%和0%。术后TG水平、低钙血症或永久性声带麻痹方面无显著差异。开放性甲状腺切除术后2.5%的患者和内镜甲状腺切除术后25.2%的患者发生短暂性声带麻痹（p<0.0001），但在3个月内消失。内镜甲状腺切除术后美容效果极佳。
内镜甲状腺切除术的双侧腋窝-乳房（BAB）入路除短暂性声带麻痹外，术后并发症不明显，美容效果良好。它也是全甲状腺切除术的一种可行方法。因此，内镜全甲状腺切除术的BAB入路可作为某些甲状腺癌病例的手术治疗选择。
