Kim Eun Young, Lee Kwan Ho, Park Yong Lai, Park Chan Heun, Lee Cho Rok, Jeong Jong Ju, Nam Kee-Hyun, Chung Woong Youn, Yun Ji-Sup
1 Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea.
2 Department of Surgery, Yonsei University College of Medicine , Seoul, Republic of Korea.
J Laparoendosc Adv Surg Tech A. 2017 Nov;27(11):1158-1164. doi: 10.1089/lap.2016.0669. Epub 2017 Apr 12.
The aim of this study is to compare the feasibility and oncologic safety of Single-incision, gasless, Endoscopic trans-axillary bilateral Total thyroidectomy (SET) with open cervical total thyroidectomy in patients with papillary thyroid carcinoma (PTC).
From March 2008 to December 2012, PTC patients underwent bilateral total thyroidectomy. Conventional, open surgery was performed on 538 patients (Group O) and endoscopic surgery was performed on 200 patients (Group E). We analyzed the patient's clinicopathologic, postoperative complications, and surgical completeness.
The mean ages of the patients were 48.9 ± 0.5 (range = 24-77) in Group O and 39.5 ± 0.8 (range = 17-73) in Group E with statistical significance (P < .001). Percentage of female patients were 74.3% in Group O and 96.0% in Group E with statistical significance (P < .001). The postoperative hospital stay in Group O was significantly longer than Group E (4.60 ± 0.05 versus 3.30 ± 0.05; P < .001). The operation time in Group E was significantly longer than Group O (93.9 ± 1.3 versus 142.6 ± 3.3; P < .001). More transient hypocalcemia was found in Group O compared to Group E with statistical significance (28.1% versus 22.4%; P < .001). There were no significant differences with respect to permanent hypocalcemia, permanent recurrent laryngeal nerve palsy, seroma, and hematoma. The mean 1 year-stimulated sTg was 0.23 ± 0.03 and 0.18 ± 0.02 in Group O and E, respectively. Tumor recurrence during short-term follow-up at neck ultrasonography (1 year) was detected in 4 patients in Group O.
SET is safe and effective, not only for low-risk patients with early-detected cancer, but also for selected cases of advanced cancer.
本研究旨在比较单切口、免气腹、内镜经腋窝双侧甲状腺全切除术（SET）与开放性颈部甲状腺全切除术治疗甲状腺乳头状癌（PTC）患者的可行性及肿瘤学安全性。
2008年3月至2012年12月，PTC患者接受双侧甲状腺全切除术。538例患者接受传统开放性手术（O组），200例患者接受内镜手术（E组）。我们分析了患者的临床病理、术后并发症及手术完整性。
O组患者的平均年龄为48.9±0.5岁（范围=24-77岁），E组为39.5±0.8岁（范围=17-73岁），差异有统计学意义（P<0.001）。O组女性患者比例为74.3%，E组为96.0%，差异有统计学意义（P<0.001）。O组术后住院时间显著长于E组（4.60±0.05天对3.30±0.05天；P<0.001）。E组手术时间显著长于O组（93.9±1.3分钟对142.6±3.3分钟；P<0.001）。与E组相比，O组发现更多短暂性低钙血症，差异有统计学意义（28.1%对22.4%；P<0.001）。在永久性低钙血症、永久性喉返神经麻痹、血清肿和血肿方面无显著差异。O组和E组1年刺激后血清甲状腺球蛋白（sTg）平均值分别为0.23±0.03和0.18±0.02。O组4例患者在颈部超声短期随访（1年）期间检测到肿瘤复发。
SET不仅对早期发现癌症的低风险患者安全有效，对部分晚期癌症病例也安全有效。
