腔镜甲状腺近全切除序贯131I消融治疗分化型甲状腺癌

目的 探讨腔镜甲状腺近全切除序贯131I消融治疗分化型甲状腺癌的效果。方法 2008年1月至2011年3月，西南医院乳腺中心对27例术前检查无明显淋巴结转移、直径小于4cm、未侵出甲状腺被膜的低危分化型甲状腺癌患者进行腔镜手术治疗，术后完成131I消融治疗1～3次，此后口服左甲状腺素治疗，将TSH调至正常低限。结果 27例均完成腔镜甲状腺近全切除术。采用胸乳径路17例，腋乳径路10例。手术时间60～180min，平均105min。出血量10～80mL，平均20mL。术后住院时间4～8d，平均5.6d。术后出现暂时性喉返神经麻痹2例，均于3个月后恢复。经4～38月(平均12月)随访，患者均未出现转移或复发征象。TSH刺激条件下TG＞10ng/mL者2例(分别为16.44ng/mL和31.0ng/mL)，其余25例TG为0～7.74ng/mL(平均2.36ng/mL)。患者对颈部外观均非常满意。结论 腔镜甲状腺近全切除术序贯131I消融治疗分化型甲状腺癌安全有效，并可避免常规开放手术所致巨大疤痕，适用于无明显淋巴结转移的低危分化型甲状腺癌患者。

Endoscopic near total thyroidectomy followed by radioiodine remnant ablation in differentiated thyroid carcinoma

Objective To explore the effect of endoscopic near total thyroidectomy followed by radioiodine remnant ablation (RRA) in differentiated thyroid carcinoma. Methods Between January 2008 and March 2011, 27 cases of differentiated thyroid carcinoma, with the diameter of smaller than 4cm, without obvious lymph nodal metastases and extraglandular invasion, underwent endoscopic operation followed by RRA. Results The endoscopic near total thyroidectomy was finished in all of 27 patients. Among them, the chest and breast approach was used in 17 cases, and the axillary and breast approach was used in 10 cases. The operation time was 60-180min, with the mean time of 105min. Blood loss was 10~80mL (mean, 20mL). Post-operative hospital stays were 4~8 days (mean, 5.6 days). Temporality injury of recurrent laryngeal nerve occurred in 2 cases and healed after 3 months. No recurrence or metastases were found in all of patients after a follow-up of 4~38 months (mean, 12 months). TG stimulated by TSH was more than 10ng/mL in 2 cases, while 0~7.74ng/mL (mean, 2.36ng/mL) in other cases. All patients were satisfied with the neck appearance. Conclusions Considering the high safety, radical efficacy and favorable cosmetic outcome, endoscopic near total thyroidectomy followed by RRA is suitable for those patients with low risk differentiated thyroid carcinoma absenting obvious nodal metastases.