Yan H, Wang Y, Huang P, Hong Y, Ye Q, Xie Q, Zhao Q, Wang P
Department of Thyroid Surgery, Second Affiliated Hospital, Zhejiang University, Hangzhou, China.
Department of Ultrasound, Second Affiliated Hospital, Zhejiang University, Hangzhou, China.
Niger J Clin Pract. 2019 Dec;22(12):1772-1777. doi: 10.4103/njcp.njcp_120_19.
There are various endoscopic techniques for thyroid carcinoma dissection but few reports regarding the scarless neck technique and central compartment dissection (CCD) via the breast approach, especially for bilateral CCD are available. In this study, we reported 45 cases with scarless neck endoscopic total or near-total thyroidectomy plus CCD via the breast approach.
Forty-five female patients with papillary thyroid carcinoma (PTC) were enrolled in the study, from January 2011 to March 2013. In brief, 5 mm ultrasonic coagulation device (Harmonic Scalpel, HS; Ethicon Endosurgery, USA) was used to perform thyroid vessel management and thyroidectomy. Twenty patients underwent total thyroidectomy and 25 underwent near-total thyroidectomy. CCD was performed in all 45 patients, including 13 with bilateral CCD and 32 with ipsilateral CCD.
The procedure was successful for all 45 patients. Sixteen patients (35.6%) had lymph node metastases in central compartments. Postoperative transient adverse events included voice changes (9 patients) and hypocalcemia (18 patients), including 7 (21.9%) in the unilateral group and 11 (84.6%) in bilateral group. There was no permanent hypocalcemia or recurrent laryngeal nerve (RLN) palsy. None of the case were converted to open surgical procedure. All patients were satisfied with the cosmetic result of the scarless neck endoscopic thyroidectomy (SET). No evidence of residual or recurrent disease was found during a mean follow-up of 22.84 months (range, 12-34 months).
Experienced thyroid surgeons performed the scarless neck endoscopic total or near-total thyroidectomy plus unilateral or bilateral CCD via the breast approach for selected PTC patients. The procedure was safe and feasible with excellent cosmetic results.
甲状腺癌切除术有多种内镜技术，但关于经乳房入路的颈部无痕技术及中央区淋巴结清扫术（CCD）的报道较少，尤其是双侧CCD。在本研究中，我们报告了45例经乳房入路行颈部无痕内镜下甲状腺全切除术或近全切除术加CCD的病例。
2011年1月至2013年3月，45例女性乳头状甲状腺癌（PTC）患者纳入本研究。简而言之，使用5毫米超声凝血装置（谐波手术刀，HS；美国强生公司Ethicon Endosurgery）进行甲状腺血管处理及甲状腺切除术。20例行甲状腺全切除术，25例行甲状腺近全切除术。45例患者均行CCD，其中13例为双侧CCD，32例为同侧CCD。
45例患者手术均成功。16例患者（35.6%）中央区有淋巴结转移。术后短暂不良事件包括声音改变（9例）和低钙血症（18例），其中单侧组7例（21.9%），双侧组11例（84.6%）。无永久性低钙血症或喉返神经（RLN）麻痹。无一例转为开放手术。所有患者对颈部无痕内镜甲状腺切除术（SET）的美容效果满意。平均随访22.84个月（范围12 - 34个月），未发现残留或复发疾病迹象。
经验丰富的甲状腺外科医生对选定的PTC患者经乳房入路行颈部无痕内镜下甲状腺全切除术或近全切除术加单侧或双侧CCD。该手术安全可行，美容效果极佳。
