Miccoli Paolo, Materazzi Gabriele, Berti Piero
Department of Surgery, University of Pisa, Italy.
Curr Opin Otolaryngol Head Neck Surg. 2010 Apr;18(2):114-8. doi: 10.1097/MOO.0b013e3283378239.
To summarize recent papers in the literature with respect to minimally invasive thyroidectomy and discuss indications and limits of the endoscopic/video-assisted treatment of differentiated thyroid carcinoma.
During the 1990s, with the general tendency to develop minimally invasive operations, an endoscopic approach was applied to neck surgery for both parathyroidectomy and thyroidectomy. The most wide spread minimally invasive technique for thyroidectomy is minimally invasive video-assisted thyroidectomy (MIVAT).
Papillary carcinoma is the main indication for MIVAT, this cancer usually being found in normal glands of young women. In contrast, for locally invasive carcinomas, lymph node metastasis or both, the procedure must be immediately converted to the conventional technique. MIVAT also is not indicated for the treatment of medullary and anaplastic carcinomas. Recent prospective randomized studies clearly demonstrate that MIVAT allows the same clearance to be achieved at the thyroid bed level and the same outcome as with the conventional technique, when dealing with 'low-risk' papillary carcinoma. At the same time, patients can benefit from the main advantages of this minimally invasive technique: less postoperative pain, faster postoperative recovery and excellent cosmetic outcome.
总结近期文献中关于微创甲状腺切除术的论文，并讨论内镜/视频辅助治疗分化型甲状腺癌的适应证和局限性。
在20世纪90年代，随着发展微创外科手术的总体趋势，内镜技术被应用于颈部手术，包括甲状旁腺切除术和甲状腺切除术。甲状腺切除术中应用最广泛的微创技术是微创视频辅助甲状腺切除术（MIVAT）。
乳头状癌是MIVAT的主要适应证，这种癌症通常在年轻女性的正常腺体中发现。相比之下，对于局部侵袭性癌、淋巴结转移或两者皆有的情况，手术必须立即转换为传统技术。MIVAT也不适用于髓样癌和未分化癌的治疗。近期的前瞻性随机研究清楚地表明，在处理“低风险”乳头状癌时，MIVAT在甲状腺床水平能达到与传统技术相同的清除效果和相同的预后。同时，患者可以从这种微创技术的主要优点中获益：术后疼痛减轻、术后恢复更快以及美容效果极佳。
