Runge Tina, Inglin Roman, Riss Philipp, Selberherr Andreas, Kaderli Reto M, Candinas Daniel, Seiler Christian A
Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Waehringer Gürtel 18-20, 1090, Vienna, Austria.
Langenbecks Arch Surg. 2017 Mar;402(2):257-263. doi: 10.1007/s00423-016-1545-6. Epub 2017 Jan 3.
Minimal access thyroidectomy, using various techniques, is widely known, but respective data on thyroidectomy for thyroid cancer with lymphadenectomy is scarce. The present study aims to evaluate the feasability of extended subplatysmal dissection in combination with a small incision ("mobile window" technique).
A retrospective study was performed analysing data from 93 patients. All patients suffered from thyroid carcinoma and underwent (total) thyroidectomy, bilateral cervico-central (levels VI and VII) and functional lateral neck dissection (levels II to V) on the side of the malignancy. In group A, consisting of 47 patients, the operation was performed by a traditional Kocher incision (minimal range 6-7 cm), in 46 patients (group B) a mini-incision (≤4 cm) was made. Intra- and postoperative morbidity as well as oncological accuracy were assessed.
There was no significant difference between the two groups comparing postoperative pathological diagnosis, intra- and postoperative complications and the number of removed lymph nodes. However, operating time was slightly longer in group A and thyroid weight was heavier in group B.
Extended subplatymsal dissection allows thyroidectomy and even lateral lymphadenectomy for thyroid carcinoma via "mobile" mini-incision. The procedure is safe, of equivalent oncological accuracy compared to traditional incision and the cosmetic results are excellent.
采用各种技术的微创甲状腺切除术广为人知，但关于甲状腺癌甲状腺切除术联合淋巴结清扫术的相关数据却很稀少。本研究旨在评估扩大颈阔肌下清扫术联合小切口（“移动窗口”技术）的可行性。
进行了一项回顾性研究，分析了93例患者的数据。所有患者均患有甲状腺癌，并接受了（全）甲状腺切除术、双侧颈中央区（Ⅵ和Ⅶ区）及患侧功能性侧颈清扫术（Ⅱ至Ⅴ区）。A组由47例患者组成，手术采用传统的科赫尔切口（最小范围6 - 7厘米），46例患者（B组）采用小切口（≤4厘米）。评估了术中及术后发病率以及肿瘤学准确性。
两组在术后病理诊断、术中及术后并发症以及切除淋巴结数量方面无显著差异。然而，A组手术时间稍长，B组甲状腺重量较重。
扩大颈阔肌下清扫术可通过“移动”小切口进行甲状腺癌的甲状腺切除术甚至侧颈淋巴结清扫术。该手术安全，与传统切口相比肿瘤学准确性相当，美容效果极佳。
