【作者】 王平； 王勇； 徐少明； 燕海潮； 谢秋萍； 赵群仔；

【机构】 浙江大学医学院附属第二医院甲状腺外科；

【摘要】 Objective:The purpose of this report was to evaluate the feasibility and safety of"scarless"(in the neck)endoscopic total or near total thyroidectomy plus central compartment dissection(CCD)via breast approach.Methods:From January 2011 to March 2013,45 female patients with papillary thyroid carcinoma(PTC)were included in this study.20 patients were performed with total thyroidectomy;near total thyroidectomy was performed in 25 patients.CCD was performed in all of the 45 patients,including 13 with bilateral CCD and 32 with ipsilateral CCD.Preoperative contrast-enhanced ultrasound(CEUS)and enhanced computed tomography(CT)scan were performed on the patients with suspected metastatic neck lymph nodes or the patients with tumor size>1cm.If the parathyroid glands were mistakenly cut or could not be preserved in situ due to the lack of blood supply,they should be transplanted endoscopically into sternocleidomastoid via syringe needle.Negative pressure drainage tube was placed via areolar incision and removed after 24-72 hours,according to postoperative drainage volume.Results:This procedure was performed successfully in all of the 45 patients with mean operation time of167.25±42.32 minutes.The mean operation time was 154.5±36.47 and 201.25±39.97 minutes in the unilateral and bilateral CCD groups,respectively.16 patients(35.6%)had lymph node metastases in central compartments.Mean lymph node yield(LNY)was 7.53±4.96 versus 10.46±7.47 in the unilateral and bilateral CCD groups,respectively.Postoperative transient voice changes occurred in 9 patients.Postoperative transient hypocalcemia occurred in 18 cases(40%),including 7(21.9%)in unilateral group and 11(84.6%)in bilateral group.Neither permanent hypocalcemia nor permanent recurrent laryngeal nerve(RLN)palsy was noted.No case was converted to open surgical procedure.All patients were satisfied with the cosmetic result of"scarless"(in the neck)endoscopic thyroidectomy(SET).No evidence of residual or recurrent disease was found during a mean follow-up of 22.84months(range,12-34).There was no significant bleeding during the operation.Conclusions:The"scarless"(in the neck)endoscopic total or near total thyroidectomy plus unilateral or bilateral CCD via breast approach for selected PTC patients could be performed feasibly and safely with excellent cosmetic results by experienced thyroid surgeons.更多还原

【Abstract】 Objective:The purpose of this report was to evaluate the feasibility and safety of "scarless"(in the neck)endoscopic total or near total thyroidectomy plus central compartment dissection(CCD) via breast approach.Methods:From January 2011 to March 2013,45 female patients with papillary thyroid carcinoma(PTC) were included in this study.20 patients were performed with total thyroidectomy;near total thyroidectomy was performed in 25 patients.CCD was performed in all of the 45 patients,including 13 with bilateral CCD and 32 with ipsilateral CCD.Preoperative contrast-enhanced ultrasound(CELTS) and enhanced computed tomography(CT) scan were performed on the patients with suspected metastatic neck lymph nodes or the patients with tumor size >1cm.If the parathyroid glands were mistakenly cut or could not be preserved in situ due to the lack of blood supply,they should be transplanted endoscopically into sternocleidomastoid via syringe needle.Negative pressure drainage tube was placed via areolar incision and removed after 24-72 hours,according to postoperative drainage volume.Results:This procedure was performed successfully in all of the 45 patients with mean operation time of167.25 ± 42.32 minutes.The mean operation time was 154.5 ± 36.47 and 201.25 ± 39.97 minutes in the unilateral and bilateral CCD groups,respectively.16 patients(35.6%) had lymph node metastases in central compartments.Mean lymph node yield(LNY) was 7.53 ± 4.96 versus 10.46 ± 7.47 in the unilateral and bilateral CCD groups,respectively.Postoperative transient voice changes occurred in 9 patients.Postoperative transient hypocalcemia occurred in 18 cases(40%),including 7(21.9%) in unilateral group and 11(84.6%) in bilateral group.Neither permanent hypocalcemia nor permanent recurrent laryngeal nerve(RLN) palsy was noted.No case was converted to open surgical procedure.All patients were satisfied with the cosmetic result of "scarless"(in the neck) endoscopic thyroidectomy(SET).No evidence of residual or recurrent disease was found during a mean follow-up of 22.84months(range,12-34).There was no significant bleeding during the operation.Conclusions:The "scarless"(in the neck) endoscopic total or near total thyroidectomy plus unilateral or bilateral CCD via breast approach for selected PTC patients could be performed feasibly and safely with excellent cosmetic results by experienced thyroid surgeons.更多还原