Wang Ping, Li Zhi-yu, Xu Shao-ming
Department of General Surgery, Second Affiliated Hospital, Zhejiang University, Hangzhou 310009, China.
Zhonghua Wai Ke Za Zhi. 2008 Oct 1;46(19):1480-2.
To evaluate the operative feasibility and safety of endoscopic thyroidectomy through anterior chest and breast approach for the treatment of the patients with papillary thyroid microcarcinoma (PTMC).
Endoscopic thyroidectomy was attempted in 164 patients with thyroid diseases. For 28 cases, which were diagnosed as PTMC by frozen section intraoperatively, lobotomy plus central compartment dissection and contralateral subtotal lobotomy was achieved completely by endoscopic thyroidectomy. There were 27 females and 1 male, and their average age was 35.2 years old. Twelve and sixteen cases were diagnosed preoperatively as thyroid microcarcinomas and benign tumors, respectively.
The operation time of the 28 cases was (115 +/- 43) min. The maximum diameter of PTMC was 0.2 to 1.0 cm with a mean of 0.56 cm. 17.9% (5/28) of the PTMC patients had transient vocal cord palsy and restored after 1 to 2 months postoperatively. There were no complications such as subcutaneous emphysema and postoperative bleeding and postoperative hypocalcaemia. 46.4% (13/28) had node involvement of the central compartment. Postoperative ultrasonography and scintigraphy showed no evidence of recurrence or residual thyroid tissue in the thyroid bed where lobotomy was performed.
The endoscopic thyroidectomy through anterior chest and breast approach is a choice of the surgical treatment for selected cases of PTMC.
评估经胸前入路内镜甲状腺切除术治疗甲状腺微小乳头状癌（PTMC）患者的手术可行性及安全性。
对164例甲状腺疾病患者尝试行内镜甲状腺切除术。术中经冰冻切片确诊为PTMC的28例患者，通过内镜甲状腺切除术成功完成了患侧叶切除加中央区淋巴结清扫及对侧次全叶切除。其中女性27例，男性1例，平均年龄35.2岁。术前分别有12例和16例被诊断为甲状腺微小癌和良性肿瘤。
28例患者手术时间为（115±43）分钟。PTMC最大直径为0.2～1.0 cm，平均0.56 cm。17.9%（5/28）的PTMC患者出现短暂性声带麻痹，术后1～2个月恢复。未发生皮下气肿、术后出血及术后低钙血症等并发症。46.4%（13/28）患者中央区有淋巴结转移。术后超声及闪烁扫描显示，行叶切除的甲状腺床无复发或残留甲状腺组织迹象。
经胸前入路内镜甲状腺切除术是部分PTMC患者手术治疗的一种选择。
