Sasaki Akira, Nitta Hiroyuki, Otsuka Koki, Obuchi Toru, Kurihara Hideo, Wakabayashi Go
Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-8505, Japan.
World J Surg. 2009 Jan;33(1):67-71. doi: 10.1007/s00268-008-9783-6.
The aim of this study was to evaluate the feasibility and outcomes of endoscopic subtotal thyroidectomy for Graves' disease.
From August 1998 to April 2008, a total of 100 patients with benign thyroid diseases underwent endoscopic thyroidectomy via the breast approach. Among these patients, 42 underwent subtotal thyroidectomy for Graves' disease.
The resection was successfully completed endoscopically in 41 patients (98%). Overall, the mean operating time, mean blood loss, and mean resected thyroid weight were 277 minutes, 76 ml, and 49.9 g, respectively. As the resected thyroid weight increased, the operating time was significantly prolonged and the blood loss significantly increased. Morbidities included one permanent and one temporary case of recurrent laryngeal nerve palsy with hypocalcemia. A hypertrophic scar was seen in the right breast medial margin in three men. Thyroid function was classified as euthyroidism, hypothyroidism, and recurrent hyperthyroidism in 5, 34, and 3 patients, respectively. At 92 months of median follow-up, two patients had modest operation-associated symptoms: one with swallowing discomfort and another with paresthesia in the anterior chest wall at the time of discharge. However, both patients' symptoms disappeared within 36 months after surgery. Young women were highly satisfied, with an overall mean satisfaction rating of 9.3 points.
Although the endoscopic approach may be relatively contraindicated for large thyroid glands, endoscopic subtotal thyroidectomy via the breast approach is a safe, feasible procedure with excellent cosmetic benefits, and it may be the procedure of choice in carefully selected patients with Graves' disease.
本研究的目的是评估内镜下甲状腺次全切除术治疗Graves病的可行性及疗效。
1998年8月至2008年4月，共有100例良性甲状腺疾病患者经乳晕入路行内镜甲状腺切除术。其中，42例因Graves病行甲状腺次全切除术。
41例患者（98%）成功完成内镜下切除。总体而言，平均手术时间、平均失血量和平均切除甲状腺重量分别为277分钟、76毫升和49.9克。随着切除甲状腺重量的增加，手术时间显著延长，失血量显著增加。并发症包括1例永久性和1例暂时性喉返神经麻痹伴低钙血症。3例男性患者右乳晕内侧缘出现增生性瘢痕。甲状腺功能分别为甲状腺功能正常、甲状腺功能减退和复发甲亢的患者有5例、34例和3例。中位随访92个月时，2例患者有轻度手术相关症状：1例出院时吞咽不适，另1例前胸壁感觉异常。然而，2例患者的症状均在术后36个月内消失。年轻女性满意度较高，总体平均满意度评分为9.3分。
尽管对于大甲状腺腺体，内镜入路可能相对禁忌，但经乳晕入路内镜甲状腺次全切除术是一种安全、可行的手术，具有极佳的美容效果，对于精心挑选的Graves病患者可能是首选手术方式。
