Hong Yun, Yu Shi-Tong, Cai Qian, Liang Fa-Ya, Han Ping, Huang Xiao-Ming
Department of Gland Surgery, Guangzhou Panyu Central Hospital, Guangzhou, 511400, People's Republic of China.
Department of Otorhinolaryngology-Head and Neck Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, People's Republic of China.
Eur Arch Otorhinolaryngol. 2016 Oct;273(10):3401-6. doi: 10.1007/s00405-016-3971-z. Epub 2016 Mar 10.
The aim of this study was to evaluate the safety, feasibility, effectiveness, and cosmesis of a gasless endoscopic-assisted thyroidectomy via the anterior chest in patients with Graves' disease. We retrospectively reviewed 38 patients with Graves' disease treated with thyroidectomy from November 2007 to June 2015. We analyzed clinical characteristics of patients, type of operation, operative indications, operative duration, length of postoperative hospital stay, and postoperative complications. The thyroidectomies were classified as total thyroidectomy (n = 12) or near-total thyroidectomy with a remnant of <1 g (n = 26). Surgical indications were recurrence after antithyroid drugs (ATDs) and unwillingness to undergo radioiodine therapy (n = 27), local compressive symptoms (n = 2), adverse drug reactions to ATDs (n = 5), and patient's preference (n = 4). Mean resection weight was 71.7 ± 16.2 g (range 44-109 g), mean operative duration 87.7 ± 17.3 min (range 66-136 min), intraoperative blood loss 70.6 ± 11.3 mL (range 43-92 mL), and drainage was 42.0 ± 8.5 mL (range 20-62 mL). Temporary postoperative recurrent laryngeal nerve palsy and temporary hypoparathyroidism occurred in 3 cases (7.89 %) each. Mean hospital stay was 2.5 ± 0.3 days (range 2-4 days). There was no recurrence of hyperthyroidism over the follow-up period of for 68.1 ± 5.6 months (range 6-89 months). All patients were satisfied with their cosmetic results. Gasless endoscopic-assisted thyroidectomy via the anterior chest approach for Graves' disease is a safe, feasible, and effective and provides an excellent cosmetic outcome procedure. It is a valid option in appropriately selected patients.
本研究旨在评估经前胸无充气内镜辅助甲状腺切除术治疗Graves病患者的安全性、可行性、有效性及美容效果。我们回顾性分析了2007年11月至2015年6月期间接受甲状腺切除术治疗的38例Graves病患者。分析了患者的临床特征、手术类型、手术指征、手术时间、术后住院时间及术后并发症。甲状腺切除术分为全甲状腺切除术（n = 12）或残留甲状腺组织<1g的近全甲状腺切除术（n = 26）。手术指征包括抗甲状腺药物（ATD）治疗后复发且不愿接受放射性碘治疗（n = 27）、局部压迫症状（n = 2）、对ATD的药物不良反应（n = 5）以及患者的个人意愿（n = 4）。平均切除重量为71.7±16.2g（范围44 - 109g），平均手术时间87.7±17.3分钟（范围66 - 136分钟），术中出血量70.6±11.3mL（范围43 - 92mL），引流量为42.0±8.5mL（范围20 - 62mL）。术后暂时性喉返神经麻痹和暂时性甲状旁腺功能减退各发生3例（7.89%）。平均住院时间为2.5±0.3天（范围2 - 4天）。在68.1±5.6个月（范围6 - 89个月）的随访期内，无甲亢复发。所有患者对美容效果均满意。经前胸入路无充气内镜辅助甲状腺切除术治疗Graves病是一种安全、可行、有效的手术方法，美容效果良好。对于合适选择的患者，这是一种有效的选择。
