Huang Xiao-ming, Sun Wei, Hong Yun, Cai Qian, Liang Fa-ya, Han Ping
Department of Otorhinolaryngology Head and Neck Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2012 Jul;47(7):571-4.
To evaluate the feasibility and safety of endoscopic thyroidectomy via anterior chest approach for early papillary thyroid cancer (T1N0M0).
From July 2004 to December 2010, 91 patients with early papillary thyroid cancer underwent minimally invasive endoscopic thyroidectomy via anterior chest approach. The clinical and pathologic characteristics of patients, operation types, operative time, postoperative hospital stay time, and postoperative complications were analyzed retrospectively.
All 91 operations were successfully performed endoscopically. There was no case conversed to open surgery. The mean tumor size was (0.96 ± 0.71) cm. The operation types included unilateral lobectomy (41 cases), unilateral subtotal lobectomy (3 cases), ipsilateral lobectomy and contralateral subtotal lobectomy (42 cases), and bilateral total thyroidectomy (5 cases). Central compartment node dissection was carried out in 39 cases with the tumor diameter less than 1.0 cm and in 29 cases with the tumor diameter of 1.0 - 2.0 cm. The mean operating time was (99 ± 17) min, the mean bleeding volume was (18 ± 12) ml, and the mean post-operative hospital stay time was (3 ± 1) days. Temporary recurrent laryngeal nerve (RLN), paresis occurred in 2 cases and recovered within 1 to 2 months after the surgery. One patient showed permanent RLN paralysis. Two patients showed temporary hypoparathyroidism. No patient showed post-operative seroma and tracheal injury. There was no case with injury to the superior laryngeal nerve. No further complications, such as irritating cough, tetany, and emphysema developed after the operation. With the anterior chest wall approach, all patients had no surgical scar on the neck and thus they were satisfied with the cosmetic outcomes. All patients were disease free by follow-up of 7 to 85 (58.4 ± 17.2) months.
Minimally invasive endoscopic thyroid surgery through anterior chest approach is a feasible and safe method for the treatment of early papillary thyroid cancer. This technique had better cosmetic results and the long-term effect of this technique needs further evaluation.
评估经胸前入路内镜甲状腺切除术治疗早期甲状腺乳头状癌（T1N0M0）的可行性及安全性。
2004年7月至2010年12月，91例早期甲状腺乳头状癌患者接受了经胸前入路的微创内镜甲状腺切除术。回顾性分析患者的临床及病理特征、手术方式、手术时间、术后住院时间及术后并发症。
91例手术均成功通过内镜完成，无1例中转开放手术。肿瘤平均大小为（0.96±0.71）cm。手术方式包括单侧甲状腺叶切除术（41例）、单侧甲状腺次全切除术（3例）、同侧甲状腺叶切除加对侧甲状腺次全切除术（42例）及双侧甲状腺全切除术（5例）。肿瘤直径小于1.0 cm的39例及肿瘤直径为1.0 - 2.0 cm的29例行中央区淋巴结清扫。平均手术时间为（99±17）分钟，平均出血量为（18±12）ml，平均术后住院时间为（3±1）天。2例出现暂时性喉返神经麻痹，术后1至2个月恢复。1例患者出现永久性喉返神经麻痹。2例患者出现暂时性甲状旁腺功能减退。无患者出现术后血清肿及气管损伤。无患者出现喉上神经损伤。术后未发生刺激性咳嗽、手足抽搐及气肿等进一步并发症。采用胸前壁入路，所有患者颈部均无手术瘢痕，因此对美容效果满意。所有患者经7至85（58.4±17.2）个月的随访均无疾病复发。
经胸前入路的微创内镜甲状腺手术是治疗早期甲状腺乳头状癌的一种可行且安全的方法。该技术具有较好的美容效果，其长期疗效有待进一步评估。
