Kang Sang-Wook, Jeong Jong Ju, Yun Ji-Sup, Sung Tae Yon, Lee Seung Chul, Lee Yong Sang, Nam Kee-Hyun, Chang Hang Seok, Chung Woong Youn, Park Cheong Soo
Department of Surgery, Yonsei University College of Medicine, Seodaemun-gu, Seoul, South Korea.
Endocr J. 2009;56(3):361-9. doi: 10.1507/endocrj.k08e-306. Epub 2009 Jan 9.
During the past decade, various techniques of endoscopic thyroid surgery have been introduced. We have developed a novel method of gasless endoscopic thyroidectomy via an axillary approach. The present report describes the technique of this method, and analyzes its surgical outcome.
Between Nov. 2001 and Dec. 2007 (actual operation period was 50 months), 581 patients with thyroid tumors underwent gasless endoscopic thyroidectomy via an axillary approach. The clinical and pathologic characteristics of patients, operation type, operation time, post operative hospital stay and post operative complications were analyzed retrospectively.
Among the 581 patients, 171 patients had benign tumor and 410 patients had malignant tumor. There was no conversion to open surgery. The operating time and the length of post-operative hospital stay were 129.4+/-51.3 minutes, 3.3+/-1.7 days in benign tumor, and 135.5+/-47 minutes, 3.4+/-0.9 days in malignant tumors, respectively. The tumor size was 2.7+/-1.2 cm in benign tumor and 0.78+/-0.5 cm in malignancy. Central compartment lymph node metastasis was found in 112 (27.3%) patients and lateral neck lymph node metastasis in 13 (3.1%) patients. As post-operative complications, transient hypocalcemia occurred in 19 patients and transient hoarseness was in 13 patients and permanent vocal cord palsy occurred in 2 patients. In the TNM stage, 366 (89.2%) patients were stage I, 43 (10.5%) patients were stage III and 1 (0.2%) patient was stage IVA.
According to our experience, gasless endoscopic thyroidectomy using a trans-axillary approach is a feasible and safe method. Endoscopic thyroid surgery has become a new treatment modality for the patients with benign tumors and can be an effective alternative treatment for the selected patients with thyroid cancer.
在过去十年间，多种内镜甲状腺手术技术被引入。我们开发了一种通过腋窝入路的无气内镜甲状腺切除术新方法。本报告描述了该方法的技术，并分析其手术结果。
2001年11月至2007年12月（实际手术时间为50个月），581例甲状腺肿瘤患者接受了通过腋窝入路的无气内镜甲状腺切除术。对患者的临床和病理特征、手术类型、手术时间、术后住院时间及术后并发症进行回顾性分析。
581例患者中，171例为良性肿瘤，410例为恶性肿瘤。无中转开放手术情况。良性肿瘤患者的手术时间和术后住院时间分别为129.4±51.3分钟、3.3±1.7天，恶性肿瘤患者分别为135.5±47分钟、3.4±0.9天。良性肿瘤的肿瘤大小为2.7±1.2厘米，恶性肿瘤为0.78±0.5厘米。112例（27.3%）患者发现中央区淋巴结转移，13例（3.1%）患者发现侧颈淋巴结转移。术后并发症方面，19例患者发生短暂性低钙血症，13例患者出现短暂性声音嘶哑，2例患者发生永久性声带麻痹。在TNM分期中，366例（89.2%）患者为I期，43例（10.5%）患者为III期，1例（0.2%）患者为IVA期。
根据我们的经验，经腋窝入路的无气内镜甲状腺切除术是一种可行且安全的方法。内镜甲状腺手术已成为良性肿瘤患者的一种新治疗方式，并且对于部分选定的甲状腺癌患者而言可作为一种有效的替代治疗方法。
