腔镜辅助颈部小切口甲状腺切除术治疗甲状腺癌

腔镜甲状腺手术以其美观、微创、并发症少及术后恢复快等优点应用于甲状腺良性疾病的治疗,目前已获得广泛认可,但对于其应用于治疗甲状腺癌的安全性、可行性等问题仍存在争议.我院自2006年1月至2008年12月行腔镜辅助颈部小切口甲状腺术式切除甲状腺癌15例,手术效果良好,现报告如下.     

小切口切除术治疗甲状腺瘤的临床疗效观察

目的 探讨小切口切除术治疗甲状腺瘤的临床疗效.方法 选取2019年7月至2020年7月间上海市浦东新区浦南医院收治的80例甲状腺瘤患者,采用随机数表法分为观察组和对照组,每组40例.观察组患者采用小切口甲状腺瘤切除术治疗,对照组患者采用传统甲状腺切除术治疗,比较两组患者的临床疗效、手术指标、疼痛情况及并发症.结果 观察...     

超声刀在小切口甲状腺腺叶切除术中的应用

目的 探讨超声刀在小切口甲状腺腺叶切除术中的应用.方法 回顾分析泉州医学高等专科学校附属人民医院56例采用超声刀小切口行甲状腺腺叶切除术的临床资料,对超声刀在小切口的疗效进行分析.结果 56例手术顺利,术中平均出血量20 mL,平均手术时间为54 min.患者术后均未出现声音嘶哑及继发出血或血肿等并发症.切口均一期愈合,术后平均住院时间4.6天.结论 应用超声刀小切口切除甲状腺叶具有出血少、恢复快、并发症少的优点,值得临床推广.     

低位小切口切除术治疗甲状腺瘤的疗效及安全性分析

目的 探讨低位小切口切除术治疗甲状腺瘤的临床疗效及安全性.方法 将150例甲状腺瘤患者根据随机数字法分为对照组(传统手术切除术)和观察组(低位小切口切除术),每组各75例,比较2组术中、术后情况,以及并发症发生情况.结果 与对照组相比,观察组切口大小、手术时间、术中出血量均明显减少,P＜0.05;与对照组相比,观察组术后48 h引流量、住院时间均明显减少,美观评分明显增高,P＜0.05.与对照组相比,观察组颈区感觉异常、疼痛,切口粘连,皮下结节,吞咽不便等并发症发生率均显著降低,P ＜0.05.结论 低位小切口切除术治疗甲状腺瘤具有疗效显著、恢复快、并发症少、安全性高等特点,值得临床推广.     

超低位颈前小切口甲状腺腺瘤切除术和传统手术的临床效果比较

目的：探讨颈前超低位小切口甲状腺腺瘤切除术的疗效,临床经验和手术注意事项,并与传统手术进行比较。方法：将我院术前确诊的单发最大直径小于4cm的26例行颈前超低位小切口切除的甲状腺腺瘤患者的临床资料与同期具有可比性的30例传统手术患者临床资料进行回顾性分析。结果：两组患者的肿块均被完整切除,切口均Ⅰ期愈合,术后无声音嘶哑、呛咳、继发血肿等并发症,无手术死亡病例。超低位小切口组患者的疤痕长度、术中出血量、患者满意度、住院天数及医疗费用明显优于对照组,差异有统计学意义（P〈0．05）,手术时间差异无统计学意义（P〉0．05）。结论：颈前超低位小切口甲状腺腺瘤手术创伤小、切口美观、费用低、能有效避免神经、血管损伤、并发症少,值得临床推广。     

超低位颈前小切口甲状腺腺瘤切除术和传统手术的临床效果比较

目的:探讨颈前超低位小切口甲状腺腺瘤切除术的疗效,临床经验和手术注意事项,并与传统手术进行比较.方法:将我院术前确诊的单发最大直径小于4cm的26例行颈前超低位小切口切除的甲状腺腺瘤患者的临床资料与同期具有可比性的30例传统手术患者临床资料进行回顾性分析.结果:两组患者的肿块均被完整切除,切口均I期愈合,术后无声音嘶哑、呛咳、继发血肿等并发症,无手术死亡病例.超低位小切口组患者的疤痕长度、术中出血量、患者满意度、住院天数及医疗费用明显优于对照组,差异有统计学意义(P＜0.05),手术时间差异无统计学意义(P＞0.05).结论:颈前超低位小切口甲状腺腺瘤手术创伤小、切口美观、费用低、能有效避免神经、血管损伤、并发症少,值得临床推广.     

腔镜辅助下小切口甲状腺切除术—119例病例回顾

目的:探讨腔镜辅助下小切口甲状腺切除术(minimally invasive video-assisted thyroidectomy,MIVAT)的可行性和临床应用。方法:自2012年1月-2013年12月,回顾性分析119例行MIVAT病人的临床资料,总结临床效果及并发症情况。结果:119例均手术成功,其中甲状腺单叶切除62人,全切除57人,平均手术时间（98.5±26.7）min vs （126.7±37.1）min。术后病理结果:结节性甲状腺肿42人,腺瘤性甲状腺肿32人,腺瘤9人,乳头状癌26人,滤泡状癌6人,桥本氏病4人。暂时性和永久性的喉返神经损伤分别为4人和2人。暂时性的低钙血症单叶和全切术分别为2人和7人。无永久性低钙血症发生。美容效果在术后1月及6月评价为好或非常好的分别为101人（84%）和112人（94%）。4人术后伤口感染。结论:MIVAT是一种安全可行的术式,在美容效果及术后恢复方面有其独特的优势,并发症未增多。     

腋下小切口肺叶切除术

目的：探索腋下小切口实施肺叶切除术的可行性,从而达到利于并加快肺部手术后恢复的目的。方法：采用腋下小切口对１６ 例肺部肿瘤的患者实施了肺叶切除或肺癌根治性手术,使其原有的肺部手术切口缩短到平均长度仅１１２８ｃｍ 。结果：１）伤口小、肌肉损伤小、出血少,因开关胸时间短,故整体手术时间缩短。２） 采用腋下藏匿式小切口,伤口美观隐蔽。３） 切口入路不横断胸壁肌肉、不切除肋骨,并且关胸时不缝扎肋间神经,术后伤口疼痛轻、持续时间短,利于患者术后咳痰及胸部物理治疗。４） 切口不需牵拉肩胛骨,术后肩关节及上肢活动受影响小,并且恢复快,有利于患者术后早期下床活动及生活自理。结论：此术式的完善和推广将会带来良好的社会效益和经济效益     

全甲状腺切除术治疗甲状腺癌的临床分析

目的探讨甲状腺癌行全甲状腺切除术的诊疗经验。方法回顾性分析83例甲状腺癌行全甲状腺切除术的临床资料及病理特点并进行1—5年随访观察。结果83例中67例为首次手术,16例为二次手术;48例术后行^131I内照射治疗;83例均术后服用甲状腺激素。随访75例中有2例死于转移癌。结论术前评估对制定甲状腺癌的治疗方案有重要意义,全甲状腺切除术辅以术后甲状腺激素抑制治疗,并适当予以放射性碘治疗,是兼顾患者预后和生活质量治疗甲状腺癌的合理选择。     

小切口甲状腺叶切除术对甲状腺乳头状癌患者免疫功能及血清甲状腺球蛋白、紧密连接蛋白-1的影响

目的 探讨小切口甲状腺叶切除术对甲状腺乳头状癌患者免疫功能及血清甲状腺球蛋白(TG)、紧密连接蛋白-1(Claudin-1)的影响。方法 选取2015年1月至2021年6月于河南科技大学第一附属医院确诊为甲状腺乳头状癌的患者共80例作为研究对象,根据随机数字表法均分为对照组和观察组,每组40例,观察组采用小切口甲状腺叶切除术,对照组采用传统甲状腺切除术。比较2组患者手术前后免疫功能,血清TG、Claudin-1水平,治疗效果,并发症发生情况。结果 与同组术前比较,观察组和对照组患者术后CD3⁺、CD4⁺及CD4⁺/CD8⁺数值均升高(观察组：t=16.830,P<0.001;t=22.680,P<0.001;t=29.480,P<0.001;对照组：t=10.350,P<0.001;t=19.480,P<0.001;t=13.630,P<0.001),且观察组术后均高于对照组(t=7.646,P<0.001;t=3.276,P=0.002;t=21.389,...     

超声刀与传统手术行甲状腺全切除术的疗效观察

目的 探讨超声刀与传统手术在甲状腺全切除术中的应用效果.方法 选取2018年2月至2019年5月间上海杨浦区市东医院收治的88例恶性甲状腺癌和良性甲状腺疾病患者,采用计算机程序随机分为超声刀组和传统手术组,每组44例.超声刀组患者采用超声刀治疗,传统手术组患者采用常规电刀治疗,比较两组患者手术时间、切口长度、术中出血量...     

Evaluation of the surgical completeness after total thyroidectomy for differentiated thyroid carcinoma.

BACKGROUND: To quantify the rate of patients without thyroid remnants, to identify predictive factors for the absence of residual thyroid tissue and to evaluate number, site, size and function of thyroid remnants after total thyroidectomy for differentiated thyroid carcinoma (DTC). METHODS: Thousand one hundred and seventy-eight patients who underwent total thyroidectomy for DTC were evaluated; 343 patients with lymph node or distant metastases and 115 patients with detectable thyroglobulin autoantibodies (TgAb) were excluded. (131)I ablative treatment (RAI) without preliminary diagnostic (131)I whole body scans (DxWBS), and 24-h (131)I quantitative neck uptake (RAIU test) and thyroglobulin (Tg) off L-T4 evaluation were performed in the remaining 720 pts. In 252 patients a 99mTc-pertechnetate pre-operative thyroid scan (99mTc-scan) was used for comparison with (131)I neck scans after RAI to evaluate site of thyroid remnants. Only patients with thyroid remnants were evaluated for successful ablation 6-10 months after RAI. RESULTS: Post-treatment whole body scan (TxWBS) demonstrated lack of thyroid remnants in 50/720 patients and the best predictive factors for the absence of residual thyroid tissue were RAIU <1% and undetectable Tg off L-T4. Thyroid remnants were present in 670/720 patients. In 252 patients with (99m)Tc-scan, 617 sites of functioning thyroid tissue were found: 381 within and 236 outside the thyroid bed. Complete successful ablation was achieved in 610/670 patients with thyroid remnants. CONCLUSIONS: This study confirms that most patients (93.1%) have thyroid remnant after total thyroidectomy for DTC. Most thyroid remnants were contralateral to tumour site and were even observed outside thyroid bed. However, a real total thyroidectomy, demonstrated by negative TxWBS, RAIU <1% and undetectable Tg off L-T4, was achieved in 6.9% of patients.     

Clinical efficacy and inflammatory reaction of submental endoscopic thyroidectomy versus conventional thyroidectomy: A prospective randomized study

ObjectivesThis prospective study aimed to explore the clinical efficacy and inflammatory reaction of submental endoscopic thyroidectomy versus conventional thyroidectomy.MethodsWe prospectively recruited 45 patients (total 90 patients) who met the eligibility criteria to undergo conventional open thyroidectomy or submental endoscopic thyroidectomy from January 2021 to July 2022 in the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. These patients were evaluated using the following indices: number of lymph nodes dissected, complications, pain severity, inflammatory indicators, cosmetic satisfaction, and economic cost. All data were analyzed by the t-test or chi-squared test.ResultsNinety patients were enrolled. The two groups did not significantly differ regarding baseline characteristics. All patients who underwent thyroidectomy had a similar trauma index and increased level of inflammation. There were no significant differences between the open thyroidectomy and submental endoscopic thyroidectomy groups in the total number of lymph nodes dissected, number of positive lymph nodes, drainage volume, and complications. The Vancouver scar score and cosmetic satisfaction score were significantly better in the submental endoscopic thyroidectomy group than the open thyroidectomy group. The submental endoscopic thyroidectomy group had a significantly lower pain scores on postoperative days 1 and 2, less downtime, and cheaper medical and esthetic costs than the open thyroidectomy group.ConclusionCompared with conventional open thyroidectomy, submental endoscopic thyroidectomy did not increase the degree of trauma, had superior clinical efficacy, caused less pain, required a shorter downtime, achieved a better cosmetic effect, and was associated with lower healthcare costs.     

全甲状腺切除治疗甲状腺癌686例体会

目的:探讨全甲状腺切除手术适应证的选择和并发症的防治,评价全甲状腺切除手术的安全性。方法:回顾性分析河南省肿瘤医院头颈外科2009-2014年间686例全甲状腺切除手术患者的临床病理资料。结果:术中采用精细化被膜操作,全组至少原位保留甲状旁腺一枚。每例均至少合并一侧Ⅵ区淋巴清扫。全组发生暂时性甲状旁腺功能低下者225例（32.8%）,出现低钙血症症状者132例（19.2%）,2例发生永久性甲状旁腺功能低下。发生喉返神经损伤者18例（2.6%）。结论:全甲状腺切除是安全的手术方式,在严格掌握手术适应证的基础上,通过术中精细的被膜操作,可有效保护喉返神经及甲状旁腺,降低术后并发症。     

86例青少年甲状腺癌的临床分析

目的 探讨青少年甲状腺癌的临床病理特点、最佳治疗方法及预后。方法 86例患者均以手术治疗为主,辅以内分泌治疗,少数患者加^131Ⅰ内照射治疗。结果 全组乳头状癌73例(84．9％),滤泡状癌6例(7．0％),乳头滤泡状癌4例(4、7％),髓样癌3例(3．5％)。颈部淋巴结转移59例(68．6％),其中双侧甲状腺癌并双颈部淋巴结转移者16例,占27.1％。肺转移11例。术后复发6例。本组颈部淋巴结转移率、双侧甲状腺受侵犯伴双颈淋巴结转移率、肺转移率均明显高于成年人。84例获5年以上随访,5年生存率95．3％(82／86)。41例获10年以上随访,10年生存率87．8％(36／41)。结论 青少年甲状腺癌颈部肿块临床表现大多数无特异性,难以与其他颈部肿块鉴别,易误诊,应引起临床高度重视。治疗手段以手术为主,预后良好。既使已有肺转移,手术加^131Ⅰ内照射的综合治疗仍能获得较满意疗效。     

甲状腺切除联合同期双侧颈淋巴结清扫术治疗分化型甲状腺癌

目的 探讨分化型甲状腺癌行甲状腺切除联合同期双侧颈淋巴结清扫（颈清）术的安全性、适应证和手术难点。方法对1991年1月至2004年6月我科收治的分化型甲状腺癌行甲状腺切除联合同期双侧颈清术患者36例作回顾性分析,手术切口选择根据原发癌灶的位置及颈淋巴结可疑转移情况,选择相应的H型、L型或衣领式,甲状腺组织行近全切或全切,双侧颈清术原则上按保留颈内静脉、副神经、胸锁乳突肌改良颈清术式进行。结果全组36例患者无一例手术死亡,术后并发症为创口出血2例,一侧喉返神经损伤4例,一侧喉上神经内支损伤2例,一侧喉上神经外支损伤9例,一侧副神经损伤3例,一侧颈交感神经损伤5例,一侧膈神经损伤2例,一侧乳糜瘘6例,暂时性甲状旁腺功能减退13例,永久性甲状旁腺功能减退3例。淋巴结阳性数0-21个,平均8．3个／例,双侧淋巴结均阳性31／36,一侧淋巴结阳性,另一侧淋巴结阴性3／36,双侧淋巴结均阴性2／36。经1-13年随访,4例死亡,7例失访,25例存活,3例复发。结论分化型甲状腺癌行甲状腺切除联合同期双侧颈清术是安全的,关键是至少保留一侧颈内静脉,不要同时损伤双侧喉返神经和膈神经;对双侧颈淋巴结病理证实转移或临床判断转移（淋巴结明显肿大、质地偏硬或淋巴结为典型的紫葡萄颜色）的分化型甲状腺癌,均应行甲状腺切除联合同期双侧颈清;至少保留一个有血供的甲状旁腺;尽可能将甲状腺组织近全切或全切;应兼顾手术彻底性和机体功能保留。     

Treatment efficacy between total thyroidectomy and lobectomy for patients with papillary thyroid microcarcinoma: A systemic review and meta-analysis

Introduction

This systemic review and meta-analysis was to determine whether the recurrence and mortality rates in papillary thyroid microcarcinoma (PTMC) patients were lower when treated with total thyroidectomy (TT) compared to thyroid lobectomy (TL).