全腔镜甲状腺微小癌的手术探讨——附14例报道

目的 在总结全腔镜甲状腺良性疾病手术的基础上探讨甲状腺微小乳头状癌（papillary thyroid microcarcinoma, PTMC）的手术可行性。方法 对60例甲状腺良性疾病患者、新开展的14例PTMC患者全腔镜手术的临床资料进行回顾性分析，总结、分析全腔镜PTMC手术的可行性及经验。结果 甲状腺良性病变的腔镜手术中，结节平均大小（2.79±0.66）cm，手术时长（162.77±32.39）min。14例腔镜下PTMC中，均行单侧腺叶全切+同侧中央（Ⅵ）区淋巴结清扫，平均肿瘤直径（0.65±0.26）cm，平均单侧手术时长（200.77±24.37）min，清扫中央区淋巴结（5.73±2.86）个，术中中位出血量为17 ml。14例腺叶均完整切除，其中4例出现术后暂时性无症状性低钙血症，未出现声音嘶哑。结论 在具有一定全腔镜甲状腺良性疾病手术经验的基础上，选择PTMC行全腔镜手术是安全、可行的；钢丝拉钩、纳米碳、神经监测等辅助技术可用来充分暴露视野及提高手术的安全性。

Total Endoscopic Thyroid Microcarcinoma Surgery: A Report of 14 Cases

Objective To discuss the feasibility of total endoscopic thyroidectomy on papillary thyroid microcarcinoma (PTMC) on the basis of the summary of benign thyroid diseases. Methods We summarized and analyzed the feasibility and experience of total endoscopic thyroidectomy of PTMC based on the retrospective analysis of the clinical data of 60 patients with benign thyroid diseases and 14 PTMC patients underwent total endoscopic surgery. Results In regard to the endoscopic thyroidectomy of benign thyroid diseases, the average size of the nodules was (2.79±0.66) cm and the average operation time was (162.77±32.39) min. As for the 14 cases of endoscopic thyroidectomy of PTMC, all patients undergone unilateral lobe with isthmus resection and ipsilateral lymph node dissection in the central region. The average size of the nodules was (0.65±0.26) cm and the average operation time was (200.77±24.37) min. The number of dissected central lymph nodes was (5.73±2.86). The median amount of intraoperative bleeding was 17ml. Unilateral lobe in 14 cases were completely removed. Among them, four cases occurred postoperative transient asymptomatic hypocalcemia, and no hoarseness. Conclusion Based on the experience of total endoscopic thyroidectomy of benign thyroid disease, it is safe and feasible to select PTMC for endoscopic surgery. Auxiliary techniques, such as carbon nanoparticles, neural monitoring, etc., could be used to fully expose the vision and improve the safety of operation.