微小乳头状甲状腺癌的腔镜手术治疗

目的探讨腔镜手术治疗微小乳头状甲状腺癌（papillary thyroid microcarcinoma,PTMC）的可行性、有效性及安全性。方法2006年3月~2008年9月,行经胸乳入路腔镜下甲状腺手术204例,术中冰冻切片检查报告PTMC 16例,在腔镜下行患侧甲状腺腺叶全切除＋对侧腺叶次全切除＋Ⅵ区淋巴结清扫术。结果16例手术时间70~160 min,平均115min。肿瘤最大径0.2~1.0 cm,平均0.56 cm。2例（12.5%）术后一过性喉返神经损伤导致暂时性声音嘶哑,术后1~2个月恢复。无术后出血、皮下气肿、饮水呛咳以及低血钙。术后病理报告均为PTMC。Ⅵ区淋巴结清扫数目2~10个,平均4.6个,其中6例（37.5%）淋巴结有癌转移。随访时间6~30个月,平均18个月,其中7例〉24个月,B超和单光子发射计算机断层扫描（ECT）提示患侧甲状腺无残留腺体,局部无复发。结论腔镜甲状腺手术治疗PTMC是安全可行的,可作为PTMC手术治疗的一种选择。

Endoscopic-assisted Surgical Management of Papillary Thyroid Microcarcinoma

Objective To evaluate the feasibility,efficacy and safety of endoscopic thyroidectomy in the treatment of papillary thyroid microcarcinoma（PTMC）.Methods Endoscopic thyroidectomy through the anterior chest and breast approach was performed on totally 204 patients with thyroid diseases between March 2006 and September 2008.Among these patients,16 cases were diagnosed with PTMC by intraoperative frozen section examination and thus were treated with lobotomy plus central compartment dissection and contralateral subtotal lobatomy by using endoscopy.Results The mean operation time of the 16 cases was 115 min（rang,70-160 min）,and the maximum diameter of the tumors ranged 0.2 cm to 1.0 cm with a mean of 0.56 cm.Two of the cases（12.5%） suffered from temporary hoarseness after the operation due to transient recurrent laryngeal nerve injury and then were cured spontaneously in 1-2 months.No episodes of postoperative bleeding,subcutaneous emphysema,wet cough or hypocalcaemia occurred in this series of patients.The PTMC was confirmed by postoperative pathological examination in all the cases.During the operation,a mean of 4.6（2 to 10） lymph nodes in the Ⅵ area were dissected,and lymph node metastasis were demonstrated in 6 cases（37.5%）.The patients were followed up for 6-30 months（mean： 18 months;24 months in 7 cases）,during which B-ultrasonography and ECT showed neither residual thyroid tissue nor recurrence in the surgical area.Conclusion Endoscope thyroidectomy is safe and feasible for PTMC.