Miccoli P, Ambrosini C E, Berti P
Department of Surgery, University of Pisa, Pisa, Italy.
Minerva Endocrinol. 2009 Mar;34(1):71-80.
Thyroid carcinoma can be divided in two main groups, differentiated, with a good prognosis and an average 10 years survival ranging from 70% to 95%, and undifferentiated which is lethal in few months. Differentiated thyroid carcinoma can be distinguished in those variants coming from follicular cells (papillary and follicular) and those from C cell (medullary carcinoma). Surgical approach represents the first step in the treatment of thyroid carcinoma. Minimally-invasive endoscopic technique can be applied only to a minority of case, the so called ''low risk'' carcinoma according to AGES and AMES criteria. During the last ten years many different endoscopic approaches have been proposed for the treatment of thyroid carcinoma and the minimally invasive videoassisted (MIVAT) by Prof Miccoli is undoubtly the one which resulted to be the most successful and spread all over the world. Through a 1.5 cm central skin incision 2 cm above the sternal notch MIVAT allows to perform a total thyroidectomy for low risk papillary carcinoma with a completeness similar to that of conventional thyroidectomy. Using the same central access it is also possible to perfom a prophylactic central neck dissection for RET gene positive carriers. A lateral neck minimally invasive videoassisted lymphadenectomy is under development for those patients with low risk papillary carcinoma and isolated lateral lymph node metastasis.
甲状腺癌主要可分为两组，即分化型，预后良好，平均10年生存率在70%至95%之间；以及未分化型，在数月内即可致死。分化型甲状腺癌又可分为源于滤泡细胞的亚型（乳头状癌和滤泡状癌）以及源于C细胞的亚型（髓样癌）。手术治疗是甲状腺癌治疗的第一步。微创内镜技术仅适用于少数病例，即根据AGES和AMES标准所谓的“低风险”癌。在过去十年中，人们提出了许多不同的内镜治疗方法来治疗甲状腺癌，而米科利教授提出的微创视频辅助手术（MIVAT）无疑是最成功且在全球范围内广泛应用的方法。通过在胸骨切迹上方2厘米处做一个1.5厘米的中央皮肤切口，MIVAT能够对低风险乳头状癌进行全甲状腺切除术，其切除完整性与传统甲状腺切除术相似。利用相同的中央入路，对于RET基因阳性携带者也可行预防性中央区颈淋巴结清扫术。针对低风险乳头状癌且伴有孤立性侧方淋巴结转移的患者，一种侧方颈部微创视频辅助淋巴结清扫术正在研发中。
