Jeryong K, Jinsun L, Hyegyong K, Eilsung C, Jiyoung S, Insang S, Moonsang A, Jiyeon K, Jaeeun H
Department of Surgery, College of Medicine, Chungnam National University, 640, Daesadong, Daejeon, 301-721, South Korea.
World J Surg. 2008 Nov;32(11):2488-93. doi: 10.1007/s00268-008-9693-7.
Endoscopic surgery for thyroid nodules is used by many endocrine surgeons. The present study reviews our experiences with endoscopic thyroidectomy using bilateral breast areola and ipsilateral axillary (BBIA) approach to evaluate its safety and feasibility.
From June 2003 through November 2007, the study group was comprised of 68 consecutive patients with benign thyroid nodules (66 women; mean age, 33.28 +/- 10.3 (range, 15-72) years). A detailed description of the surgical technique is provided.
The mean maximum diameter of the tumor was 3.14 +/- 1.61 (range, 1-10.7) cm. Sixty-five cases were successfully resected with an endoscopic procedure, but three cases were converted to a conventional open procedure due to bleeding. Endoscopic procedures were 61 lobectomies, 2 isthmectomies, and 2 near total thyroidectomies. The mean operating time was 89.93 +/- 24.71 (range, 50-170) minutes, and the last 32 cases tended to take less time than the first 33 cases (P = 0.033). No CO2 gas-related complications, such as subcutaneous emphysema or hypercapnia, were observed. There was no case of permanent recurrent laryngeal nerve injury or hypoparathyroidism. The mean length of the hospital stay was 5.37 +/- 1.5 (range, 3-11) days.
Endoscopic thyroidectomy using BBIA approach is safe and feasible. The cosmetic results were considered excellent by all patients. The advantages of this approach are no cervical or chest wall scar, and no significant morbidity.
许多内分泌外科医生采用内镜手术治疗甲状腺结节。本研究回顾了我们采用双侧乳晕和同侧腋窝（BBIA）入路进行内镜甲状腺切除术的经验，以评估其安全性和可行性。
2003年6月至2007年11月，研究组由68例连续的良性甲状腺结节患者组成（66例女性；平均年龄33.28±10.3岁（范围15 - 72岁））。提供了手术技术的详细描述。
肿瘤的平均最大直径为3.14±1.61cm（范围1 - 10.7cm）。65例通过内镜手术成功切除，但3例因出血转为传统开放手术。内镜手术包括61例叶切除术、2例峡部切除术和2例近全甲状腺切除术。平均手术时间为89.93±24.71分钟（范围50 - 170分钟），后32例的手术时间往往比前33例短（P = 0.033）。未观察到与二氧化碳气体相关的并发症，如皮下气肿或高碳酸血症。无永久性喉返神经损伤或甲状旁腺功能减退病例。平均住院时间为5.37±1.5天（范围3 - 11天）。
采用BBIA入路的内镜甲状腺切除术安全可行。所有患者均认为美容效果极佳。该方法的优点是无颈部或胸壁瘢痕，且无明显并发症。
