Wang Cun-chuan, Hu You-zhu, Lai Zhen-wu, Yang Jing-ge, Chen Jun, Pan Yun-long, Xu Peng, Li Jin-yi
Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
Zhonghua Wai Ke Za Zhi. 2009 Jul 15;47(14):1067-9.
To investigate the feasibility and safety of endoscopic thyroidectomy via the areola of breast approach.
Between April 2005 to September 2008, endoscopic thyroidectomy via the areola of breast approach was performed in 28 female patients. Of the patients, 25 cases presented with nodular goiter, 2 cases with Grave's disease and 1 case with minimum papillary carcinoma. The average age was 22.5 years (range, 18-38 years). A 10 mm trocar was placed on the medial border of the areola of the right breast for the video-endoscopy and removing specimens, and a 5 mm trocar was placed on the lateral border of the areola of the same breast as the assisted operation hole. Another 5 mm trocar was placed on the medial border of the areola of left breast as the main operation hole. The operation data was recorded and analyzed.
All the 28 operations were successful. The procedures included one lobe total thyroidectomy in 5 cases, one lobe subtotal thyroidectomy in 15 cases, subtotal thyroidectomy in 3 cases, one lobe near total thyroidectomy + the other lobe subtotal thyroidectomy in 4 cases, and one lobe total thyroidectomy + the central group lymph node resection + the other lobe subtotal thyroidectomy in 1 case. The average operation time was 60.7 minutes (range, 40-125 minutes), the average operation blood loss was 5.8 ml (range, 2-15 ml), the average length of post-operative hospital stay was 3.1 days (range, 2-5 days). No adverse effects was found after the operation, such as damage to the parathyroid gland and the laryngeal nerve. The patients were followed-up for 1 to 40 months with satisfactory results. All 28 patients were satisfied with the cosmetic effects of the operation.
Endoscopic thyroidectomy via the areola of breast approach produces an outstanding cosmetic effect, it is safe and feasible.
探讨经乳晕入路内镜甲状腺切除术的可行性及安全性。
2005年4月至2008年9月，对28例女性患者施行经乳晕入路内镜甲状腺切除术。其中结节性甲状腺肿25例，格雷夫斯病2例，微小乳头状癌1例。平均年龄22.5岁（范围18 - 38岁）。在右乳晕内侧缘置入10 mm套管针用于视频内镜操作及取出标本，在同一乳晕外侧缘置入5 mm套管针作为辅助操作孔。在左乳晕内侧缘再置入一个5 mm套管针作为主操作孔。记录并分析手术数据。
28例手术均成功。手术方式包括一叶全切除术5例，一叶次全切除术15例，次全切除术3例，一叶近全切除术 + 另一叶次全切除术4例，一叶全切除术 + 中央组淋巴结清扫 + 另一叶次全切除术1例。平均手术时间60.7分钟（范围40 - 125分钟），平均手术出血量5.8 ml（范围2 - 15 ml），平均术后住院天数3.1天（范围2 - 5天）。术后未发现甲状旁腺及喉返神经损伤等不良反应。对患者随访1至40个月，效果满意。28例患者对手术美容效果均满意。
经乳晕入路内镜甲状腺切除术美容效果显著，安全可行。
