腔镜辅助下甲状腺手术治疗体会

目的:探讨腔镜辅助下小切口甲状腺切除术(minimally invasive video-assisted thyroidectomy，MIVAT)的临床应用。方法:自2009年12月到2014年3月，回顾性分析402例行MIVAT病人的临床资料，总结临床效果及并发症情况。结果:402例病例均手术成功，其中323例行颈前小切口、49例行锁骨下小切口手术，30例行平锁骨的长切口清扫手术。9例因不同原因中转手术。术后病理结果:结节性甲状腺肿206例，腺瘤性甲状腺肿28例，腺瘤16例，桥本氏病13例，乳头状癌120例，滤泡状癌18例，髓样癌1例。暂时性及永久性的喉返神经损伤分别为15 例（3.7%）和 7例（1.7%）。术后暂时性低钙血症单叶切除术后为2例0.8%（2/259），单叶切除+对侧结节切除术后2.3%（2/88），全切术后7例12.7%（7/55）。无永久性低钙血症出现。美容效果在术后1个月及6个月评价为好或非常好的分别为322例（80.1%）和365例（90.8%）。术后随访12~60个月，平均随访28个月，复查良、恶性病人均无异常。结论:MIVAT是一种安全可行的术式，同时可以加以拓展、改良，进一步地扩大其应用范围。MIVAT在美容效果方面有其独特的优势，且未增加并发症和复发率。

Clinical experiences of minimally invasive video-assisted thyroidectomy

Objective:To explore the clinical application of minimal invasive video-assisted thyroidectomy(MI-VAT).Methods:A retrospective study of 402 consecutive patients who underwent MIVAT was conducted,to summa-rize the clinical effects and complications.Results:MIVAT was successfully performed in all 402 patients.An above sternal small incision was used for 323 patients,subclavicular approach was used for 49 patients,30 patients under-went lateral neck dissection with a litter longer incision along the clavicle level.The final pathology report:There were 206 nodular goiter,28 adenomatous goiter,16 follicular adenoma,13 Hashimoto disease,120 papillary cancinoma,18 follicular cancinoma and 1 medullary carcinioma.Transient and permanent recurrent laryngeal nerve injury was 15 and 7 respectively.Postoperative transient hypocalcemia was diagnosed in 2,2 and 7 patients following lobectomy,lobecto-my plus contralateral nodulectomy and total thyroidectomy,respectively.No permanent hypocalcemia was found.Cos-metic effects were assessed after 1 and 6 months of follow-up as very good or excellent in 322(80.1%)and 365 (90.8%)patients,respectively.There were no recurrences in all patients in follow-up of 12~60 months.Conclu-sion:MIVAT was a safe and feasible operation which could be improved,with good cometic effects and no more com-plications and recurrences.