微小乳头状甲状腺癌的内镜手术治疗

目的 探讨微小乳头状甲状腺癌(PTMC)内镜手术治疗的可行性、有效性及安全性.方法 收集2006年3月至2007年9月经胸乳人路内镜下甲状腺手术164例患者的临床资料,对其中经术中冰冻切片检查报告为PTMC的28例患者的临床资料进行回顾性分析.28例患者平均年龄35.2岁,女性27例,男性1例.术前诊断为甲状腺微小癌的12例,结节性甲状腺肿的16例.全部PIMC患者在内镜下行患侧甲状腺腺叶全切除+对侧腺叶次全切除+Ⅵ区淋巴结清扫术.结果 平均手术时间(115±43)min.肿瘤最大径0.2～1.0 cm,平均0.56 cm.5例(17.9%)术后出现一过性声音嘶哑.无术后出血、皮下气肿、饮水呛咳以及低血钙的表现.术后病理报告均为PTMC.Ⅵ区淋巴结清扫数目2～10个,平均4.6个,其中13例(46.4%)淋巴结有癌转移.随访时间1～17个月,B超和ECT提示患侧甲状腺无残留腺体,局部无复发.结论 内镜甲状腺手术治疗PTMC是安全可行的,可作为PTMC手术治疗的一种选择.

Endoscopic thyroidectomy through anterior chest and breast approach for papillary thyroid microcarcinoma

Objective To evaluate the operative feasibility and safety of endoscopic thyroidectomy through anterior chest and breast approach for the treatment of the patients with papillary thyroid microcarcinoma (PTMC). Methods Endoscopic thyroidectomy was attempted in 164 patients with thyroid diseases. For 28 cases, which were diagnosised as PTMC by frozen section intraopratively, lobotomy plus central compartment dissection and contralateral subtotal lobotomy was achieved completely by endoscopic thyroidectomy. There were 27 females and 1 male, and their average age was 35.2 years old. Twelve and sixteen cases were diagnosed preoperatively as thyroid microcarcinomas and benign tumors, respectively. Results The operation time of the 28 cases was (115±43) min.The maximum diameter of PTMC was0.2 to 1.0 cm with a mean of 0.56 cm. 17.9% (5/28) of the PTMC patients had transient vocal cord palsy and restored after 1 to 2 months postoperatively. There were no complications such as subcutaneous emphysema and postoperative bleeding and postoperative hypocalcaemia 46. 4% (13/28) had node involvement of the central compartment. Postoperative ultrasonography and scintigraphy showed no evidence of recurrence or residual thyroid tissue in the thyroid bed where lobotomy was performed. Conclusions The endoscopic thyroidectomy through anterior chest and breast approach is a choice of the surgical treatment for selected cases of PTMC.