腔镜辅助下甲状腺乳头状癌根治术的临床效果分析

目的考察腔镜辅助下甲状腺乳头状癌根治术的临床效果分析。方法选取2014年11月至2016年11月诊治的甲状腺乳头状癌患者67例,采取随机数字法分为腔镜辅助组(34例)和开放手术组(33例)。应用SPSS 19.0统计学软件进行统计学处理,术中及术后相关临床指标以(x珋±s)的形式表示,采用独立t检验;术后并发症的总发生率及术后疼痛程度以%表示,采用χ2检验,以P0.05表示差异具有统计学意义。结果与开放手术组相比,腔镜辅助组的手术时间和术后引流量均显著增加,术中出血量和切口长度均显著降低,术后住院时间和颈部恢复活动时间均显著缩短,差异均具有统计学意义(P0.05);腔镜辅助组术后并发症的总发生率为5例(14.7%),开放手术组术后并发症的总发生率为12例(36.4%),差异具有统计学意义(P0.05);与开放手术组相比,腔镜辅助组的0级疼痛患者显著提高,Ⅱ级疼痛患者显著降低,差异均具有统计学意义(P0.05)。结论腔镜辅助下微创术治疗甲状腺乳头状癌的临床效果较好,美观性强且安全性高,值得在临床上大力推广应用。     

构建完全腔镜下甲状腺癌根治术后甲状腺乳头状癌复发的超声预测模型

目的：构建完全腔镜下甲状腺癌根治术后甲状腺乳头状癌（PTC）患者复发的超声预测模型。方法：收集2017年2月至2020年3月我院初次行完全腔镜下甲状腺癌根治术的PTC患者264例,根据术后是否复发分为复发组和无复发组。比较两组患者临床资料及结节直径、结节数目、内部回声、微钙化等超声资料。使用单因素、Lasso及Logistic回归模型分析PTC患者术后复发的影响因素,并基于筛选的指标建立列线图模型。结果：与无复发组比较,复发组患者结节直径更大,结节边缘不规则、纵横比>1、微钙化、被膜侵犯比例更高（P<0.05）。结节直径>10 mm、边缘不规则、纵横比>1、微钙化、被膜侵犯是PTC患者术后复发的独立危险因素（P<0.05）,所构建的列线图模型C-index计算结果为0.756(95%CI:0.684～0.830),ROC曲线AUC为0.895(95%CI:0.866～0.915),区分度较高;校准曲线结果显示平均偏离量为0.027,预测概率较好拟合实际概率;临床决策曲线远离极端曲线,具有良好的临床适用性。结论：基于结节大小、边缘不规则、微钙化、纵横比>...     

全腔镜与开放根治术治疗甲状腺微小乳头状癌的对比研究

背景与目的:甲状腺癌的发病率逐年上升,甲状腺癌新发患者中甲状腺微小乳头状癌(PTMC)占50%以上。手术是治疗PTMC的首选方法。本研究旨在探讨并比较全腔镜根治术与开放根治术治疗PTMC的效果。方法:选取云南省第一人民医院乳腺甲状腺外科2018年1月—2019年1月收治的80例PTMC患者资料,均为首次手术治疗且经病理证实。根据患者意愿,分为全腔镜组(n=46)和开放手术组(n=34),全腔镜组患者接受全腔镜PTMC根治术,开放手术组患者接受传统开放手术。比较两组手术时间、术中出血量、术后第1天切口引流量、引流管留置时间、住院时间、中央区淋巴结清扫数目等指标;采用视觉模拟评分法评估患者术后24h内疼痛程度;比较两组术后并发症发生率;采用调查问卷形式比较患者术后3个月对于切口美容的满意度。结果:与开放手术组相比,全腔镜组手术时间、引流管留置时间及住院时间较长,术中出血量及术后第1天切口引流量较多(P0.05);而两组在术后疼痛程度及中央区淋巴结清扫数目间无统计学差异(P0.05)。全腔镜组术后发生声音嘶哑2例,呛咳1例,手足麻木4例,切口感染1例;开放手术组出现声音嘶哑1例,手足麻木3例,无呛咳及感染病例发生,并发症发生率组间无统计学差异(P0.05)。对术后患者美容满意度进行调查,全腔镜组总满意度为86.96%,开放手术组为20.59%;全腔镜组总满意度明显高于开放手术组(P0.05)。随访期间,两组患者均未出现肿瘤复发和转移,两组患者手术的效果均达到预期。结论:全腔镜根治术可达到与开放手术相同的中央区淋巴结清扫效果,远期预后一致,且患者术后切口美容满意度明显更高,故全腔镜PTMC根治术是安全可行的,对于美容要求较高的低危型PTMC患者可视为首选。     

完全腔镜与开放手术后甲状腺微小乳头状癌患者生活质量的对比研究

目的:探讨完全腔镜与开放手术对甲状腺微小乳头状癌患者术后生活质量的影响。方法:连续收集36例行完全腔镜甲状腺切除术(totally endoscopic thyroidectomy,TET)及36例开放手术的甲状腺微小乳头状癌患者,采用EORTCQOL调查表(QLQ-C30中文版),随访记录对比术后1周、1个月、3个月、6个月、1年、2年、5年两组患者术后不适、并发症及心理社会影响等情况,分析两种术式对患者生活质量的影响。结果:两组患者术后不适如疲乏、吞咽不畅、术区压迫感、暂时性低钙症状、声音嘶哑差异无统计学意义(P0.05);术区疼痛近期TET组明显,中远期症状均缓解。TET组术后手术疤痕对患者外观、心理、社会关系的影响显著优于开放手术组。结论:TET与开放手术患者术后躯体不适及并发症发生率相近,但TET可显著降低手术瘢痕对患者心理的影响,提高患者的生活质量。     

完全腔镜下甲状腺癌改良颈淋巴结清扫术的临床应用价值

目的:探讨完全腔镜下改良颈部淋巴结清扫术治疗甲状腺乳头状癌的临床价值。方法:回顾分析2014年3月至2015年3月手术治疗的36例甲状腺乳头状癌患者的临床资料。根据手术方式分为两组,传统组行传统手术治疗(n=24),腔镜组行完全腔镜下手术(n=12)。对比两组患者的手术相关指标、手术效果及并发症发生情况。结果:腔镜组手术时间长于传统组,术中出血量较传统组少,差异有统计学意义(P0.05);淋巴结清扫数量两组差异无统计学意义(P0.05);引流管引流量腔镜组多于传统组(P0.05);住院时间传统组长于腔镜组(P0.05);术后并发症腔镜组较传统组少(P0.05)。结论:完全腔镜下甲状腺癌改良颈部淋巴结清扫术安全、可行,与传统手术方式相比,虽然手术时间较长,但术中出血量少、切口美观、并发症少、术后康复快,值得临床推广应用。     

腔镜上纵隔淋巴结清扫术在甲状腺乳头状癌治疗中的运用

目的:探讨经颈部腔镜辅助或经颈部腔镜辅助联合胸腔镜行上纵隔淋巴结清扫术(UMLND)治疗甲状腺乳头状癌的可行性。方法:回顾性分析2015年12月—2018年7月在浙江大学医学院附属邵逸夫医院头颈外科接受腔镜UMLND治疗的11例甲状腺乳头状癌患者的临床资料。男5例,女6例;年龄21～73岁,平均(45±18)岁。甲状腺腺叶切除术、中央区清扫术及侧颈清扫术在直视或腔镜辅助下完成,UMLND在经颈部腔镜辅助或腔镜辅助联合胸腔镜下完成。结果:11例患者中10例在腔镜下顺利完成手术,1例因转移淋巴结粘连无名静脉在腔镜下无法安全分离而中转开胸手术。腔镜辅助UMLND平均手术时间为(58.7±12.1)min,术后平均住院时间(9.5±9.6)d。UMLND平均获取淋巴结数目为(8.4±3.3)枚,平均转移淋巴结数目为(3.5±2.6)枚。无UMLND相关并发症发生。术后平均随访时间(16±7)个月,患者血清甲状腺球蛋白平均浓度(1.85±2.21)ng/mL,所有病例未见肿瘤残留或复发。结论:经颈部腔镜辅助或腔镜辅助联合胸腔镜行UMLND治疗甲状腺乳头状癌安全可靠,手术清扫彻底,微创美容效果明显,有较大的临床应用价值。     

全乳晕入路腔镜甲状腺微小乳头状癌根治术：附23例报告

目的:探讨应用腔镜经全乳晕入路行甲状腺微小乳头状癌根治手术的经验及效果。方法:回顾性分析2015年1月—2017年1月23例行腔镜经全乳晕入路甲状腺微小乳头状癌根治术患者的临床资料。患者均为甲状腺单发结节,肿瘤直径均≤1.0 cm;均无颈部淋巴结转移;其中女18例,男5例,平均年龄37.13岁。结果:均成功实施腔镜甲状腺癌根治术,无中转开放手术,术后无因并发症二次手术者。平均手术时间为183.83(155~221)min,平均术后引流管留置时间2.17(2~3)d,术后平均住院时间为2.39(2~5)d。术后发生轻度饮水呛咳1例,1周内恢复正常;术后出现不同程度的皮下气肿6例,1周内均自行吸收。随访至今未发现肿瘤复发、淋巴结或远处转移病例。术后随访观察患者切口瘢痕小,美容效果好。结论:全乳晕入路腔镜甲状腺微小乳头状癌根治术是一种效果确切、安全可行的方法,且美容效果好。     

腔镜技术在甲状腺微小乳头状癌治疗中应用

经过20年的发展,腔镜甲状腺切除术适应证已经扩展至分化型甲状腺癌,尤其是甲状腺微小乳头状癌（PTMC）。术前评估是关键,评估的重点是原发肿瘤的位置以及转移淋巴结的大小、位置;腔镜PTMC手术关键是如何保护喉返神经（RLN）及甲状旁腺的功能。对于初学者,或遇到喉不返神经,或二次手术的时候,术中神经监测有明显的优势。对于PTMC病人,近全甲状腺切除术代替全切除术是防止甲状旁腺永久性损伤的有效术式。目前,对于PTMC行腔镜甲状腺手术治疗,在手术入路选择及淋巴结清扫范围等方面还存在争议。     

经胸乳入路腔镜手术治疗女性单侧甲状腺微小乳头状癌的临床价值

目的:探讨经胸乳入路腔镜技术在女性单侧甲状腺微小乳头状癌手术中的应用价值.方法:回顾分析2019年1月至2020年7月收治的50例女性甲状腺微小乳头状癌患者的临床资料,根据术式分为腔镜组(n=25)与开放组(n=25).对比分析两组手术时间、中央区淋巴结清扫数量、术后引流量、置管时间、术后美容效果、术后并发症等.结果:...     

单侧早期分化型甲状腺乳头状癌不同切除术式的临床对比研究

目的:探讨开放切除术及完全腔镜切除术治疗单侧早期分化型甲状腺乳头状癌的临床疗效及安全性。方法:选取2014年3月至2014年12月收治的100例单侧早期分化型甲状腺乳头状癌患者,随机分为A组(n=50)与B组(n=50),分别采用开放切除术及完全腔镜切除术。对比两组患者围手术期临床指标、术后美容满意度、远期复发率及并发症发生率等。结果:B组患者术中出血量、术后24 h疼痛评分均显著少于A组(P0.05);A组患者手术时间显著短于B组(P0.05);两组患者总淋巴结清扫数量、阳性淋巴结清扫数量差异无统计学意义(P0.05);B组患者术后美容满意度显著高于A组(P0.05);两组患者远期复发率、术后并发症发生率差异无统计学意义(P0.05)。结论:相较传统开放手术,完全腔镜切除术治疗单侧早期分化型甲状腺乳头状癌可有效降低术中创伤程度,缓解术后疼痛,有助于提高术后美观性。     

乳晕入路全腔镜下甲状腺癌根治术与小切口甲状腺癌根治术的临床对比分析

目的:对比全腔镜下甲状腺手术与小切口甲状腺手术治疗甲状腺癌的手术效果及美容效果。方法:将33例术前行甲状腺细针穿刺抽吸诊断为甲状腺乳头状癌的患者随机分为两组,其中16行乳晕入路腔镜下甲状腺癌根治术(腔镜组),17例行腔镜辅助小切口甲状腺癌根治术(小切口组)。对比分析两组患者手术时间、淋巴结清扫数量、术后引流时间、术后并发症发生率、患者切口满意度等指标。结果:小切口组手术时间、术后引流时间均明显少于腔镜组(P0.05);两组淋巴结清扫数量、术后并发症发生率差异无统计学意义(P0.05);而腔镜组患者满意程度明显优于小切口组(P0.05)。结论:小切口甲状腺手术与腔镜甲状腺手术均属于美容手术,两者均具有良好的手术安全性及根治效果,小切口手术在手术时间、术后引流等方面优于腔镜手术,但颈部仍有2~3 cm的瘢痕。腔镜手术具有术后颈部无瘢痕的美容效果,美容效果更佳,但应严格掌握适应证。     

双侧甲状腺乳头状癌的临床诊治分析

目的探讨双侧甲状腺乳头状癌（PTC）的临床诊断及手术治疗的有关问题。方法回顾分析2005年1月至2010年6月收治的19例PTC患者的临床资料,总结其术前诊断、术中病理及手术治疗的特点。结果167例甲状腺癌患者中共发现PTC19例（11．4％）;术前通过超声造影和CT检查拟诊为双侧甲状腺癌仅1例（5．3％）;术中冰冻切片检查确诊为双侧乳头状癌17例（89．5％）。其中行双侧甲状腺切除术11例,行一侧腺叶切除加峡部及对侧甲状腺次全或部分切除7例,双侧甲状腺近全切除1例。同时行双侧中央区淋巴结清扫术5例,一侧中央区淋巴结清扫术7例,一侧功能性颈淋巴结清扫术1例。术后病理证实为中央区淋巴结转移共7例（36．8％）。结论双侧甲状腺乳头状癌的术前诊断较为困难,术前超声造影结合CT检查可提高甲状腺癌的诊断符合率。PTC手术时应以全甲状腺切除为主,并行双侧中央区淋巴结清扫。对明确有中央区淋巴结转移者,可同时行一侧功能性颈淋巴结清扫术。     

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目的 探讨甲状腺髓样癌(MTC)的病理学特点，诊断和治疗选择。方法 对1982-2001年经治的32例MTC的临床和病理资料进行分析总结。结果 32例均予手术切除原发灶或加行颈淋巴结清扫术。均经病理证实，淋巴结转移率为65．4％。术后5年、10年生存率分别为77．8％，62．5％。结论 MTC具有多分化肿瘤的特点，可产生多种神经内分泌物质，少数病人可出现类癌综合征或顽固性腹泻。MTC的治疗以根治性切除为原则，而又要比其他类型的甲状腺癌更为积极，决不可任意缩小手术范围。     

Differentiated thyroid carcinoma: comparison between papillary and follicular carcinoma in a single institute

PURPOSE: To compare and contrast the clinical presentation and treatment outcome of patients with papillary and follicular thyroid carcinoma and to study the pattern of practice of treatment of differentiated thyroid carcinoma in Hong Kong. METHOD: The clinical presentation and treatment outcomes were reviewed for 1057 patients with differentiated thyroid cancers who were treated at the Queen Elizabeth Hospital, Hong Kong, from 1960 to 1997. Eight hundred forty-two patients had papillary thyroid carcinomas (PTC), and 215 had follicular thyroid carcinomas (FTC). The mean follow-up was 9.2 years. RESULTS: The differences in the clinical factors of PTC to FTC were as follows: PTC had a higher incidence (3.9:1); these patients were younger at presentation (median age, 44 vs 49), showed a higher female-male ratio (4.5 vs 2.9) and smaller primary tumor size (median 2 cm vs 3.5 cm), and a higher incidence of multifocal disease (28.3% vs 18.1%), extrathyroidal extension (39.4% vs 14%), and more lymph node metastases (33.3% vs 12.1%). The incidence of distant metastases was higher for patients with FTC (28.8% vs 8.9%), and cause-specific survival rates were lower (p =.001). The locoregional control rates were not significantly different (p =.2). The 10-year cause-specific survival, freedom from distant metastasis, and locoregional failure figures for PTC compared with FTC were 92.1% vs 81%, 90.8% vs 72.3%, and 78.5% vs 83%. CONCLUSIONS: Although patients with PTC tend to have more advanced locoregional disease compared with those with FTC, the likelihood of locoregional control is similar, and the probability of cure is better.     

改良乳晕入路腔镜甲状腺良性肿瘤切除术的临床研究

目的:探讨改良乳晕入路腔镜甲状腺良性肿瘤切除术的手术方法及疗效。方法:回顾分析2011年1月至2012年3月为42例患者行改良腔镜甲状腺良性肿瘤切除术的临床资料,经乳沟、乳晕三孔法入路,沿标记线注射膨胀液建立手术通道,术中做好手术记录,术后继续常规治疗,随访3～6个月,以评价手术疗效。结果:手术均顺利完成,无中转开放手术。手术时间30～60 min,平均(47±5)min;术中出血量2～5 ml,平均(3±0.8)ml;术后并发症发生率为2.38%;美容效果良好,患者满意率100%。结论:改良腔镜甲状腺良性肿瘤切除术具有手术创伤小、对血管及神经损伤小、出血等并发症发生率低、美容效果好等优点,是安全、有效、可行的。     

Current therapeutic options for low-risk papillary thyroid carcinoma: Scoping evidence review

Most cases of thyroid carcinoma are classified as low risk. These lesions have been treated with open surgery, remote access thyroidectomy, active surveillance, and percutaneous ablation. However, there is lack of consensus and clear indications for a specific treatment selection. The objective of this study is to review the literature regarding the indications for management selection for low-risk carcinomas. Systematic review exploring inclusion and exclusion criteria used to select patients with low-risk carcinomas for treatment approaches. The search found 69 studies. The inclusion criteria most reported were nodule diameter and histopathological confirmation of the tumor type. The most common exclusions were lymph node metastasis and extra-thyroidal extension. There was significant heterogeneity among inclusion and exclusion criteria according to the analyzed therapeutic approach. Alternative therapeutic approaches in low-risk carcinomas can be cautiously considered. Open thyroidectomy remains the standard treatment against which all other approaches must be compared.     

Parapharyngeal lymph node metastasis: an unusual presentation of papillary thyroid carcinoma

BACKGROUND: Parapharyngeal space nodal metastases are usually secondary to malignancies of the pharynx and sinonasal tract, although localization of lymphomas is also possible. Parapharyngeal metastases arising from thyroid papillary carcinoma are instead an exceedingly rare event, with only 10 cases reported up to now in the literature. METHODS: We describe two cases of parapharyngeal metastasis from thyroid papillary carcinoma in a man and a woman, aged 40 and 52 years, respectively. RESULTS: Both patients had a lesion that clinically appeared to be located in the parapharyngeal space; they underwent CT and MRI, which detected a cystic mass in the poststyloid compartment. In the first patient, fine-needle aspiration cytology failed in identifying the histologic nature of the lesion, which was excised through a transcervical approach. A diagnosis of metastatic thyroid papillary carcinoma was rendered and therefore the patient underwent total thyroidectomy. In the second patient, a total thyroidectomy, previously scheduled for multinodular goiter, was performed along with the removal of the parapharyngeal mass. Definitive histologic findings revealed that the two parapharyngeal masses were cystic metastases from a thyroid papillary carcinoma. Both patients received postoperative 131I treatment. Twenty-four months after surgery, the first patient is free of disease, whereas the second one has clear signs of abnormal 131I uptake in the lungs. CONCLUSIONS: The differential diagnosis of a parapharyngeal poststyloid mass should also include metastasis from thyroid papillary carcinoma. When the lesion displays a cystic appearance on imaging, it is advisable to rule out a thyroid primary by ultrasonographic examination. The occurrence of a metastasis in such unusual site, even though rarely reported, does not seem to significantly affect the prognosis of the disease.     

cNo期甲状腺乳头状癌498例的外科治疗及预后

目的 探讨cNo期甲状腺乳头状癌(papillary thyroid carcinoma,PTC)颈部淋巴结状况及其与肿瘤复发及预后的关系.方法 对1986-1990年收治的498例cNo PTC患者的临床、病理及随访资料进行回顾性分析.结果 所有患者均获得10年以上的随访.498例患者16例死于本癌,其中13例因癌局部复发致死,而死于远处器官转移的仅3例.498例总颈淋巴结转移率为52.2％,其中260例患者的转移率分别为Ⅱ区14.1％、Ⅲ区27.1％、Ⅳ区24.6％、Ⅴ区12.5％、Ⅵ区20.1％.癌灶无包膜组淋巴结转移率为65.6％、侵出包膜组为64.5％、侵出腺叶组为56.5％、侵犯邻近组织组为52.0％、局灶癌变组为33.3％、隐性硬化型组为26.9％,包膜内和侵犯包膜组为0.全颈淋巴结清扫术后复发率为2％,中央区淋巴结清扫术后的复发率为9.9％.结论 本组患者死亡的主要原因是局部复发,我们建议对属于侵袭性较强的病理类型的cNo PTC患者,如病理检查发现癌已经侵出包膜、侵出腺叶、侵犯邻近组织和无包膜,应考虑行预防性功能性全颈淋巴结清扫术.     

Retropharyngeal node metastasis from papillary thyroid carcinoma

BACKGROUND: Papillary thyroid carcinomas commonly metastasize to paratracheal and jugular lymph nodes. Metastasis to the retropharyngeal node is rare for this tumor. METHODS: Five patients underwent surgical treatment for metastasis of thyroid papillary carcinoma to the retropharyngeal lymph nodes that presented as a parapharyngeal or retropharyngeal mass. All patients had a history of total or subtotal thyroidectomy as their initial treatment. Among them, 3 patients had undergone ipsilateral modified radical neck dissection at their initial treatment. The other 2 patients had a history of bilateral or ipsilateral modified neck dissection for their subsequent cervical lymph node metastases. RESULTS: Metastatic retropharyngeal nodes were successfully resected via transcervical approach in all patients. Although aspiration and difficulty in swallowing were observed in 2 patients after surgical treatment for metastatic retropharyngeal nodes, these complications spontaneously resolved within a few months. CONCLUSIONS: This study suggests that neck dissection and/or metastatic cervical lymph nodes might alter the direction of lymphatic drainage to the retrograde fashion, resulting in the unusual metastasis to the retropharyngeal lymph nodes. Although the cases described here are rare, metastasis to the retropharyngeal node should be considered at the follow-up for thyroid papillary carcinoma. Because these metastases will be missed by routine ultrasonography of the neck, periodic CT scan or MRI is recommended for follow-up, especially for patients with a history of neck dissection.