腔镜辅助技术在T1期甲状腺乳头状癌手术中的应用

目的探讨腔镜辅助技术在T．期甲状腺乳头状癌（papillary thyroid carcinoma，PTC）中央区淋巴结清扫术中的可行性。方法回顾性分析2013年1—7月我科收治并经术中冰冻切片和术后石蜡切片确诊PTC53例的临床资料，病灶最大径≤2．0cm，全麻下行单侧腺叶加峡部切除加同侧中央区淋巴结清扫术。根据病人意愿分为常规手术组（n=34）和腔镜辅助组（n=19），比较2组手术时间、出血量、清除淋巴结数目和喉返神经损伤发生率。结果手术均获成功，与常规手术组相比，腔镜辅助组切口短[中位数2．5cm（2．0～3．0cm）VS．4．6cm（3．8～5．0cm），Z=-6．039，P=0．000]，但手术时间长[（76．6±29．0）minV8．（59．7±18．3）min，t=2．609，P=0．012]。2组清除淋巴结数、出血量和声音嘶哑发生率差异无显著性（P〉0．05）。结论应用腔镜辅助技术治疗T1期甲状腺乳头状癌的效果与常规手术相似，尽管手术时间稍长，但其小切口更易于为年轻患者选择。

The Application of Video-assisted Technique in the Treatment of T1 Stage Papillary Thyroid Carcinoma

Objective To evaluate the feasibility of video-assisted technique in central lymph node dissection for T1 papillary thyroid carcinoma. Methods From January 2013 to July 2013, 53 patients with diagnoses of T1 stage papillary thyroid carcinoma by intraoperative frozen section and postoperative paraffin section underwent central lymph node dissection. The lesions were equal to or less than 2.0 cm. Unilateral lobe resection plus isthmectomy was performed. The patients were divided into conventional thyroidectomy group （CT, n = 34） and video-assisted technique group （VA, n = 19） according to their wishes. The operative time, blood loss, number of lymph nodes removed and the incidence of recurrent laryngeal nerve injury were recorded and retrospectively analyzed. Results The operations were performed successfully in all 53 patients under general anesthesia. Compared with CT group, the incision was shorter in length [median 2.5 cm （2.0 -3.0 cm） vs. 4.6 cm （3.8 -5.0 cm）, Z= -6.039, P=0.000] and operative time was longer in the VA group [ （76.6 ± 29.0） min vs. （59.7± 18.3 ） min,t = 2. 609, P = 0. 0121 ] No significant difference was found between the two groups in the number of lymph nodes removed, blood loss and incidence of recurrent laryngeal nerve injury （ P 〉 0. 05）. Conclusion Video-assisted technique in the treatment of T1 papillary thyroid carcinoma has the same clinical effect with conventional thyroideetomy. Although the operative time was prolonged, its minimal incision was more beneficial for young patients.