Wang Cunchuan, Sun Peng, Li Jinyi, Yang Wah, Yang Jingge, Feng Zhiqi, Cao Guo, Lee Shing
Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
Surg Endosc. 2016 Nov;30(11):4721-4730. doi: 10.1007/s00464-016-4814-0. Epub 2016 Mar 22.
This study was aimed at exploring the feasibility and strategies of laparoscopic thyroidectomy for treatment of substernal goiter via areola approach.
A retrospective analysis was conducted to investigate 15 cases of laparoscopic resection of substernal goiter via the areola approach (laparoscopic group) and 12 cases of open resection of substernal goiter via low-neck collar cervical approach (open group) that was completed between December 2012 and December 2014. Operative time, estimated blood loss, postoperative hospitalization and postoperative complication were compared. Follow-up data were assessed, and the mean duration of follow-up was 24.5 ± 7.5 months.
The surgery was successfully completed in 14 cases, and 1 case was intraoperatively converted to open surgery. All the procedures were successfully completed in the open group. There was no difference in the mean distance from the inferior border of the excised substernal mass to the sternal notch, operation time, intraoperative estimated blood loss, postoperative hospital stay or the drainage tubes removed. Five cases had transient hypocalcemia after surgery in the laparoscopic group, while 1 case in the open group. There were no cases of hoarseness, dysphagia, lymphatic leakage, dyspnea and death in the two groups. And there were no recurrent cases in the follow-up.
Laparoscopic thyroidectomy for the treatment of selected substernal goiter via the areola approach is feasible. Preoperative B-ultrasound and 3D-CT scan reconstruction help to select cases and formulate surgical strategies, and the way that the thyroid is suspended using silk threads intraoperatively can reduce surgical difficulties and risks of intraoperative conversion to open surgery.
本研究旨在探讨经乳晕入路腹腔镜甲状腺切除术治疗胸骨后甲状腺肿的可行性及策略。
回顾性分析2012年12月至2014年12月期间15例行经乳晕入路腹腔镜胸骨后甲状腺肿切除术的患者（腹腔镜组）和12例行经低领颈部入路胸骨后甲状腺肿开放切除术的患者（开放组）。比较手术时间、估计失血量、术后住院时间及术后并发症。评估随访数据，平均随访时间为24.5±7.5个月。
14例腹腔镜组手术成功完成，1例术中中转开放手术。开放组所有手术均成功完成。切除的胸骨后肿物下缘至胸骨切迹的平均距离、手术时间、术中估计失血量、术后住院时间或拔除引流管情况差异无统计学意义。腹腔镜组5例术后出现短暂性低钙血症，开放组1例。两组均无声音嘶哑、吞咽困难、淋巴漏、呼吸困难及死亡病例。随访期间无复发病例。
经乳晕入路腹腔镜甲状腺切除术治疗选择性胸骨后甲状腺肿是可行的。术前B超及三维CT扫描重建有助于病例选择及制定手术策略，术中丝线悬吊甲状腺的方法可降低手术难度及术中中转开放手术的风险。
