甲状腺癌外科治疗术式选择

甲状腺结节是外科医生最常见的甲状腺疾病，其中有5．0％～15．0％最终会诊断为甲状腺癌。如果针吸活检后病理结果提示为阳性或高度怀疑为恶性肿瘤，则外科手术是必须的。在过去十年中，外科医生为了追求切口小型化和创伤最小化，将腔镜技术引入到甲状腺手术中，统称为“甲状腺微创手术”，包括颈部小切口甲状腺手术、腔镜辅助下小切口甲状腺手术，简称Miccoli术式，和颈部无瘢痕存留的全腔镜下甲状腺手术，以及最近开展的机器人辅助下全腔镜甲状腺手术。所有这些手术方式都必须遵循相同的肿瘤外科手术操作原则。本文列举了目前国内关于分化型甲状腺癌的术式选择，同时还列举了国内外各种主流手术方法，并说明其优缺点，以期望对临床工作有所帮助。

Therapeutic options of surgical treatment of thyroid cancer

Thyroid nodules are a common clinical problem for surgeons. About 5.0% - 15.0% of the patients with thyroid nodules would be diagnosed as having thyroid cancer. Surgical management should be carried out if fine needle aspiration cytology is positive, or suspicious for malignancy. During the past decade, mini-invasive principles based endoscopic skills in treating thyroid nodules have been cutting-edge for gaining smaller incisions and less invasion, which is called mini-invasive thyroideetomy, including mini-incision anterior approach, endoscopy assisted thyroidectomy, so called ＂ Miccoli＂, total endoscopic surgery without scar in the neck, and robot-assisted endoscopic surgery. All of these techniques follow the same principles of surgery and ontology. This article reviewed current clinical guidelines in treating differentiated thyroid carcinoma in China, and summarized the merits and drawbacks of different surgical managements of thyroid cancer in an attempt to improve the clinical practice.