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[现代甲状腺手术:高效安全的甲状腺切除技术]

[Modern thyroid surgery : Efficient and safe thyroidectomy technique].

作者信息

Smaxwil Constantin Aurel, Zielke Andreas

机构信息

Endokrine Chirurgie, Diakonie-Klinikum Stuttgart, Rosenbergstraße 38, 70176, Stuttgart, Deutschland.

出版信息

Chirurgie (Heidelb). 2024 Oct;95(10):785-792. doi: 10.1007/s00104-024-02100-2. Epub 2024 Jun 11.

Abstract

After decades of bilateral "subtotal" and later "total" thyroidectomy, the extent of resection is now determined individually depending on the dominant thyroid condition. The leading indication by far in the study, documentation and quality center (StuDoQ) register of the Surgical Working Group Endocrinology (CAEK) is currently the suspicion of malignancy, which is followed by benign symptomatic nodular goiter, functional disorders and confirmed malignancy. The decision for an intervention as well as the extent of resection must be rigorously established. Aids for intraoperative nerve monitoring, vessel-sealing and parathyroid autofluorescence increase the safety of thyroid resections but also the complexity. The surgical technique of lobectomy using modern devices for vessel sealing is an intricate process in which the positioning, access to the neck and a modified sequence of dissection steps are equally important. While the usefulness of neuromonitoring is nowadays no longer in doubt, this is not yet so clear for other technologies. Above all, however, modern thyroid surgery is characterized by the knowledge of one's own results and a clear positioning to follow-ups. The selection of any surgical aid should be based on this knowledge.

摘要

在经历了数十年的双侧“次全”甲状腺切除术以及后来的“全”甲状腺切除术后,如今切除范围需根据主要的甲状腺病情个体化确定。目前,在内分泌外科工作组(CAEK)的研究、文档记录与质量中心(StuDoQ)登记中,到目前为止最主要的手术指征是怀疑有恶性肿瘤,其次是良性有症状的结节性甲状腺肿、功能障碍以及确诊的恶性肿瘤。必须严格确定干预决策以及切除范围。术中神经监测、血管封闭和甲状旁腺自体荧光等辅助手段提高了甲状腺切除术的安全性,但也增加了手术的复杂性。使用现代血管封闭设备进行叶切除术的手术技术是一个复杂的过程,其中定位、颈部入路以及改良的解剖步骤顺序同样重要。虽然如今神经监测的实用性已毋庸置疑,但其他技术的情况尚不明朗。然而,最重要的是,现代甲状腺手术的特点是了解自身手术结果并明确后续随访安排。任何手术辅助手段的选择都应基于这一认知。

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