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。     

腔镜技术在甲状腺结节治疗中的应用与评价

甲状腺结节是甲状腺外科的常见病,为了切除病灶或明确诊断,大多数甲状腺结节需外科手术治疗。腔镜技术在甲状腺外科的应用缩小或避免了开放手术对颈部外观的不良影响。随着手术技术的进步,腔镜下已能完成几乎所有方式的甲状腺手术,其中腔镜下甲状腺次全切除术是应用最多的手术方式。常用的手术入路包括经颈前小切口的腔镜辅助甲状腺手术以及经胸乳入路或经腋窝入路的完全腔镜下甲状腺手术。对于低危的分化型甲状腺癌,腔镜下甲状腺近全切除术代替甲状腺全切除,疗效确切,安全性高,但腔镜下颈淋巴结清扫的效果尚有争议。     

改良Miccoli术式内镜下甲状腺手术667例分析

目的 探讨腔镜辅助下颈部小切口甲状腺手术（Miccoli 术式）中的技巧,总结手术各项指标及相关经验。方法 回顾性分析2006年6月至2010年4月吉林大学第一医院甲状腺外科667例腔镜辅助下颈部小切口行甲状腺手术的临床资料。 结果 667例均顺利完成腔镜辅助甲状腺手术。前50例手术平均时间（60±13）min;后617例平均（39±9）min。术中出血量15～80mL,术后引流量5～35mL,均于第2天拔除引流管。术后住院时间（3±1）d。手术切口长2.0～2.5cm。术后均未使用止痛药, 出现暂时性声嘶1例,皮下气肿1例,中转开放手术10例。所有病例均未发生术后出血或感染。全组随访3~12个月,无一例复发。结论 腔镜辅助下颈部小切口甲状腺手术安全可靠、并发症少且美容效果相对较好,在掌握一定技巧的基础上实施,临床效果更佳,应用前景广阔。     

2种腔镜下甲状腺手术的比较

目的比较2种入路腔镜甲状腺手术的优缺点。方法乳晕入路腔镜下甲状腺腺瘤切除术10例(乳晕入路组),颈部小切口腔镜辅助甲状腺手术11例(颈部小切口组),比较2组手术时间、术中出血量、住院时间和并发症。结果21例均成功完成腔镜甲状腺手术。乳晕入路组手术时间(132.4±39.1 m in)明显长于颈部小切口组(89.2±16.8 m in,t=3.347,P=0.003)。乳晕入路组术中出血量(12.9±4.3 m l)明显少于颈部小切口组(18.2±5.5 m l,t=-2.442,P=0.025)。乳晕入路组术后住院时间(4.2±1.0 d)长于颈部小切口组(3.0±0.6 d,t=3.373,P=0.003)。21例随访6个月均未见甲状腺肿瘤复发或甲状腺功能减退。结论与颈部小切口腔镜辅助甲状腺手术相比,乳晕入路腔镜甲状腺手术手术时间较长,不易掌握,但暴露更充分,视野更清晰,术中出血少,美容效果好。     

甲状腺单发腺瘤腔镜辅助颈部小切口手术效果观察

目的探讨甲状腺单发腺瘤腔镜辅助颈部小切口手术的效果。方法选取2015-04—2017-03间平舆县中心医院收治的98例甲状腺单发腺瘤患者,按不同术式分为2组,各49例。观察组行腔镜辅助颈部小切口手术,对照组行传统手术。比较2组疗效。结果 2组并发症发生率差异无统计学意义(P0.05)。观察组手术时间长于对照组,但术中失血量、术后24 h VAS评分、住院时间及切口瘢痕满意度均优于对照组,差异有统计学意义(P0.05)。结论腔镜辅助颈部小切口手术治疗甲状腺单发腺瘤,创伤小、并发症少、切口美观满意度高,效果确切。     

经锁骨下入路行腔镜辅助甲状腺手术：附62例报告

目的探讨经锁骨下入路腔镜辅助甲状腺切除的手术方法及价值。方法对62例甲状腺腺瘤、甲状腺肿、甲状腺功能亢进、甲状腺癌等实施了经锁骨下入路的腔镜辅助下甲状腺手术。结果令组均手术成功，无中转开放手术，前25例平均手术时间为（120±32）min，后37例平均手术时间（50±13．3）min。术后住院时间（4±0．5）d。术后皮下积血2例，无声嘶，无饮水呛咳，无手足麻木等并发症；术后恢复良好。术后6个月随访62例患者，颈部皮肤感觉接近止常，颈部外形基本正常。结论论锁骨下入路腔镜下甲状腺于术具有无颈部疤痕、美容效果好、恢复快，易掌握。     

一种新的手术策略：完全经颏下单孔腔镜甲状腺癌侧颈部淋巴结清扫术

背景与目的 传统开放甲状腺癌侧颈部淋巴结清扫手术采用颈部“L形”或者“低领式长弧形”切口,手术创伤大且在颈部留下较大瘢痕。由于颈部操作空间小、解剖复杂,采用腔镜技术清扫侧颈部淋巴结难度亦较大。为此,笔者探索了一种新的手术策略—完全经颏下单孔腔镜甲状腺癌侧颈部淋巴结清扫术。本文通过介绍1例采用该术式行甲状腺癌侧颈部淋巴结清扫患者的资料,初步探讨该术式的可行性。方法 回顾分析1例中国科学技术大学附属第一医院甲乳外科2022年9月完成“完全经颏下单孔腔镜甲状腺癌侧颈部淋巴结清扫术”患者的临床资料。结果 手术时间4.1 h,术后第5天出院,无感染,无声音嘶哑,无低钙性手足麻木等并发症。患者颈部自然体位时手术切口瘢痕位于颏下凹陷处,相对隐蔽不易被发现,患者对颏下切口满意。结论 采用“颏下单孔”入路行腔镜下甲状腺癌侧颈部淋巴结清扫术安全可行,初步判断该技术具有创伤小、无明显术野盲区、切口瘢痕隐蔽等优势。     

腔镜分化型甲状腺癌根治术的难点和争议

分化型甲状腺癌具有淋巴结转移率高和患者年轻化的特点,腔镜甲状腺手术因颈部不遗留术后疤痕,近年来发展迅速并广受欢迎。对于存在侧颈部淋巴结转移的分化型甲状腺癌,全腔镜甲状腺癌功能性颈淋巴结清扫给患者带来较好的美容效果及较小的心理创伤。然而,由于该术式工程量大,对术者团队配合要求高。需要把握好手术的适应证和禁忌症。团队的协作、合理灵活运用针式辅助技术是使这该术式得以实现的关键。本文对该术式的技术难点进行阐述,分析腔镜分化型甲状腺癌根治术存在的争议。     

腔镜甲状腺手术现状与展望

传统甲状腺手术在颈部会遗留较长的手术瘢痕。为增强美容效果,上世纪90年代国内外学者开始探讨如何利用腔镜进行甲状腺手术。此后该技术发展迅速,出现了完全腔镜（endoscopicthyroidectomy,ET）和腔镜辅助的小切口甲状腺手术（minimallyinvasiverid．eoassistedthyroidectomy,MIVAT）。近年来,许多新观念、新技术、新方法在腔镜甲状腺手术领域得到应用,如术中喉返神经监测技术、机器人技术、腔镜下新解剖标志的认识、新路径的应用等等,所有这些共同促进了腔镜甲状腺外科的发展,本文就腔镜甲状腺手术的现状及展望做一介绍。     

腔镜辅助颈部小切口与传统切口甲状腺手术治疗甲状腺腺瘤效果对比研究

目的 比较腔镜辅助颈部小切口与传统切口甲状腺手术治疗甲状腺腺瘤的临床效果。方法 回顾性分析2019-12—2022-06河南大学淮河医院行手术治疗的70例甲状腺腺瘤患者的临床资料，根据手术方法分为腔镜辅助颈部小切口甲状腺手术组(观察组)与传统切口甲状腺手术组(对照组),各35例。比较2组患者的基线资料、围术期指标，以及患者对切口美容效果的满意度。结果 2组均成功完成手术，术后均顺利康复。2组患者的基线资料、手术时间差异均无统计学意义(P>0.05)。观察组患者的术中出血量、术后引流量少于对照组，术后24 h的VAS评分低于对照组，住院时间短于对照组，患者对切口美容效果的满意度高于对照组。以上差异均有统计学意义(P<0.05)。结论 与传统切口甲状腺手术比较，腔镜辅助颈部小切口手术治疗甲状腺腺瘤患者，具有手术创伤轻、术后恢复快等优势，并可提升患者对切口美容效果的满意度。但应严格把握手术适应证，以提高手术效果及安全性。     

Current topics of endoscopic surgery for thyroid cancer

Endoscopic surgery has been introduced in the field of thyroid disease. Endoscopic thyroid surgery is divided into complete endoscopic surgery using CO2 gas, which is approached from the axilla, mammary areola, and anterior chest; and video-assisted thyroid surgery without CO2 gas, approached from the neck or anterior chest under the clavicula through a small incision. Many thyroid tumors are benign, and cases of thyroid cancer are few. Only 7.9% of patients who underwent endoscopic thyroid surgery in the English and Japanese literature had papillary thyroid cancer. Most of these underwent video-assisted thyroidectomy without gas. The indications for endoscopic surgery in papillary thyroid cancer is microcancer or small tumor without lympnode metastasis before surgery. In follicular thyroid cancer, minimally invasive thyroid cancer of less than 5cm is recommended for endoscopic thyroid surgery. Furthermore, in medullary carcinoma with multiple endocrine neoplasia, prophylactic thyroidectomy can be performed using these endoscopic techniques. At present, it is still controversial whether endoscopic surgery should be performed to treat thyroid cancer.     

老年患者腔镜与开放甲状腺肿瘤摘除术的对照研究

目的:对比分析为老年患者施行腔镜与开放甲状腺肿瘤手术的临床疗效及应用价值.方法:将112例老年甲状腺肿瘤患者随机分为治疗组和对照组,每组56例,治疗组行腔镜微创切除术.对照组行传统开放手术.对比分析两组手术时间、术中失血量、术后引流量、住院时间、住院期间费用、手术疗效、切口美容评分、并发症发生率等.结果:治疗组手术时间...     

The role of fine-needle aspiration cytology in the surgical management of thyroid cancer

Background: Diagnosis of thyroid malignancy relies on clinical assessment, imaging and fine‐needle aspiration cytology ‘FNAC’ of thyroid nodules. The purpose of this study was to evaluate how effective synoptically reported FNAC is in clinical practice in diagnosing thyroid cancer. We also examined the effectiveness of using preoperative FNAC results to plan the type of operation for treating thyroid cancer. Method: A retrospective case series of all patients undergoing thyroid surgery from 1993 to 2008 was analysed. All data were collected prospectively and recorded in a dedicated endocrine surgery database. Data analysed included age, sex, preoperative FNAC result, type of surgery, final histology and complications. Cytology was reported based on a five‐tiered classification system. Results: There were 1373 patients in total and 125 patients with a final diagnosis of thyroid cancer. Female to male ratio was 3:1. Cytology reported as ‘malignant’ was confirmed as thyroid cancer in 100% of the cases. Of the patients, 47% with ‘suspicious’ cytology report and 14% with ‘follicular/indeterminate’ cytology report had a final diagnosis of cancer. Thyroid cancer subtypes were 90 patients with papillary thyroid cancer ‘PTC’, 24 with follicular ‘FTC’, eight with medullary ‘MTC’ and two with anaplastic cancer. Cytology was suggestive of cancer in 89% of the patients with PTC >10 mm, 75% with FTC and 88% with MTC. Transient hypocalcaemia was the commonest complication occurring in 7.2%. There were no cases of permanent hypoparathyroidism. Recurrent laryngeal nerve neuropraxia occurred in 2.4% with a permanent palsy occurring in 0.8%. There were three cancer‐related deaths. Conclusions: Preoperative synoptically reported FNAC is effective when used in diagnosing and planning surgery for thyroid cancer.     

超声引导下射频消融术与腔镜微创手术治疗甲状腺良性结节的应用比较

目的比较超声引导下射频消融术与腔镜微创手术在甲状腺良性结节患者治疗中的应用。 方法收集2015年1月至2019年1月于中国人民解放军联勤保障部队第九二八医院接受手术治疗的甲状腺良性结节患者1 000例,根据手术方式分为超声引导下射频消融术组（594例）和腔镜微创手术组（406例）。比较两组患者手术时间,术中出血量,术后住院时间,手术前后6个月甲状腺功能变化情况,手术前后12 h白细胞介素6（IL-6）、C反应蛋白（CRP）、肿瘤坏死因子α（TNF-α）及术后并发症发生情况。 结果射频消融术组术后IL-6、CRP和TNF-α质量浓度水平显著低于腔镜微创手术组（t=-67.827、-117.340、32.192,均P<0.001）;射频消融术组手术时间、术后住院时间、手术出血量、术后并发症发生率均显著低于腔镜微创手术组（t=85.135、67.418、65.475,χ²=169.568,均P<0.001）。 结论超声引导下射频消融术与腔镜微创手术在甲状腺良性结节患者治疗中均对甲状腺功能损伤较小,且超声引导下射频消融术安全性好、创伤小、术后并发症较少。     

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??Reasonable selection of thyroid nodule surgery range??United States and our guides interpretation DAI Wen-jie??XU De-quan??YIN Yue. Department of Thyroid and Mammary Gland Cell Transplantation Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin150001, China
Corresponding author??DAI Wen-jie??E-mail??davidhmu@163.com
Abstract Nodular thyroid disease is common in Department of Thyroid Surgery??and controversy continues to surround the management of nodular thyroid disease. The incidence of thyroid disease is increasing worldwide. The specialization of thyroid surgery combined with standard lymphadenectomy takes survival benefit for patients with differentiated thyroid carcinoma (DTC). American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer will be issued by American Thyroid Association (ATA) in 2015. The revised guidelines for the management of thyroid nodules and thyroid cancer includes recommendations regarding initial evaluation??clinical and ultrasound criteria for fine-needle aspiration (FNA) biopsy as well as use of molecular marks. Recommendations regarding the initial management of DTC include those relating to staging and risk assessment??surgical management??radioiodine remnant ablation??and TSH suppression therapy using levothyroxine. The revised guidelines make the basic principles for the treatment of thyroid nodules and DTC more scientific and accurate. It will provide important guidance for the future clinical practice.     

改良Miccoli术式内镜甲状腺手术36例临床观察

目的:探讨改良Miccoli术式内镜甲状腺手术治疗甲状腺肿瘤的临床疗效。方法:我院2011年1月至2011年12月共36例住院患者行改良Miccoli术式内镜甲状腺手术治疗甲状腺肿瘤。术后随访3个月,评价其疗效。结果:36例手术均无并发症。手术时间30～120min。平均35.3min,出血量15.5mL。多数伤口瘢痕已经吸收、变平,美容效果十分理想。结论:改良Miccoli术式内镜甲状腺手术治疗甲状腺肿瘤具有切口美观,手术创伤小,术后恢复快等优点,更易被爱美人士接受。     

腔镜甲状腺癌手术后复发特点及处理

腔镜甲状腺手术是指采用颈部或颈外入路在腔镜辅助或完全腔镜下进行的甲状腺手术。随着腔镜技术的完善、手术经验的积累和器械的研发，目前腔镜甲状腺手术适应证已扩大到早期甲状腺乳头状癌。腔镜甲状腺手术有成像放大和术后美容的优势，但也存在一些不足，如腔镜甲状腺癌手术清扫淋巴结时，可能会存在操作盲区，为肿瘤复发和转移留下隐患。腔镜甲状腺癌手术后复发的主要因素是术前评估不到位、手术操作不规范和腔镜经验不足。肿瘤或淋巴结残留是腔镜甲状腺癌手术后复发较常见的情况。腔镜甲状腺癌手术后复发时需要认真评估，多需要再次手术，多主张开放手术，处理原则同开放手术后复发灶的处理。     

Reevaluation of the surgical treatment of thyroid nodules diagnosed as cancer postoperatively

Reevaluation was carried out on the surgical treatment for clinically benign thyroid nodules. One hundred and thirty-seven patients underwent conservative resections of the thyroid because of preoperative impression of benign nodules at the First Department of Surgery, Nagoya University Hospital from 1970 to 1984. Permanent paraffin sections of the resected specimen revealed that the nodules in 4 patients were intrathyroidal cancer (3 papillary and 1 follicular) and the nodules in the other 8 patients were associated with an unsuspected small (3 approximately 15 mm) thyroid cancer. All those patients underwent either lobectomy or subtotal thyroidectomy at the initial surgery except for one patient in whom enucleation was performed. No further intervention was carried out when the definitive diagnosis was made, except for one patient in whom the enucleation was followed by lobectomy. No neck dissection was attempted in all of them. Patients have been living and well without evidence of recurrence for 3 to 11 years and one died of unrelated disease. From these results, it is recommended that lobectomy is the least requirement in treating clinically benign nodule and that, when paraffin section reveals the tumor is intrathyroidal cancer, no further surgery is justified unless there are other foci of cancer in the resected lobe.     

甲状腺结节手术范围合理选择——美国及我国相关指南解读

甲状腺结节是甲状腺外科最常见的疾病,其外科治疗一直存在争议。近年来甲状腺结节的发病率在全球范围内呈持续增长趋势。标准的甲状腺手术方式联合规范化的颈淋巴结清扫,对于改善病人的预后,具有至关重要的意义。2015年,美国甲状腺协会（ATA）将发布新版《ATA甲状腺结节和分化型甲状腺癌诊治指南》。该指南内容主要涉及良性甲状腺结节和分化型甲状腺癌（DTC）的初始超声、细针穿刺细胞学检查（FNA）及分子标记物的评估以及甲状腺癌的危险分层、外科治疗、131I治疗和TSH抑制治疗。新版ATA指南将甲状腺结节和DTC外科治疗的基本原则、概念更为科学化、精准化,为今后的临床实践提供了重要的指导作用。     

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??Application and evaluation of endoscopic technique in the surgical treatment of thyroid nodules FAN Lin-jun. Breast Disease Center, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China Thyroid nodules are common in clinical practice. Majority of patients with thyroid nodules need surgical treatment in order to remove the focus or to acquire a final diagnosis. The postoperative cervical appearance could be improved with the application of endoscopic technique in thyroid surgery. With the improvement of the
operative technique, almost all types of thyroidectomy could be completed under endoscope. Endoscopic subtotal thyroidectomy is the most common method in the treatment of thyroid nodules. The common approaches of endoscope include video-assisted thyroidectomy via cervical small incision and total endoscope thyroidectomy via breast approach or axillary approach. Comparing with the total thyroidectomy, endoscopic near-total thyroidectomy for low risk differentiated thyroid carcinoma could get better safety, lower incidence of recurrent laryngeal nerve paralysis and the same therapeutic effect. But the clearance of cervical lymph nodes is still controversial. On account of its remarkably cosmetic advantages, endoscopic operation has become the preferred method for the treatment of thyroid nodules.