中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2011年
6期
485-488
,共4页
李志宇%王平%林信斌%徐少明%王勇
李誌宇%王平%林信斌%徐少明%王勇
리지우%왕평%림신빈%서소명%왕용
甲状腺肿瘤%甲状腺切除术%颈淋巴结清扫术%内镜手术
甲狀腺腫瘤%甲狀腺切除術%頸淋巴結清掃術%內鏡手術
갑상선종류%갑상선절제술%경림파결청소술%내경수술
Thyroid neoplasms%Thyroidectomy%Neck dissection%Video-assisted surgery
目的 探讨经胸乳入路内镜手术治疗甲状腺乳头状癌的可行性、有效性及安全性.方法 回顾性分析2006年3月至2010年3月间浙江大学医学院附属第二医院内镜手术治疗的85例甲状腺乳头状癌患者的临床资料.结果 84例患者手术成功,平均手术时间113.3 min.84例均行中央区清扫,其中12例怀疑颈侧区淋巴结转移者加行患侧颈侧区清扫.平均清扫淋巴结数目在中央区为6.5个,在颈侧区为19.2个.6例(7.14%,6/84)出现术后暂时性声音嘶哑,4例(4.76%,4/84)术后发生一过性低血钙症状.随访9~57个月,B超和ECT提示患侧无残留腺体,局部无复发,颈部外观良好,所有患者对手术效果均满意.结论 内镜甲状腺手术治疗严格选择的甲状腺乳头状癌是安全可行的,但其远期效果还有待长期随访观察.
目的 探討經胸乳入路內鏡手術治療甲狀腺乳頭狀癌的可行性、有效性及安全性.方法 迴顧性分析2006年3月至2010年3月間浙江大學醫學院附屬第二醫院內鏡手術治療的85例甲狀腺乳頭狀癌患者的臨床資料.結果 84例患者手術成功,平均手術時間113.3 min.84例均行中央區清掃,其中12例懷疑頸側區淋巴結轉移者加行患側頸側區清掃.平均清掃淋巴結數目在中央區為6.5箇,在頸側區為19.2箇.6例(7.14%,6/84)齣現術後暫時性聲音嘶啞,4例(4.76%,4/84)術後髮生一過性低血鈣癥狀.隨訪9~57箇月,B超和ECT提示患側無殘留腺體,跼部無複髮,頸部外觀良好,所有患者對手術效果均滿意.結論 內鏡甲狀腺手術治療嚴格選擇的甲狀腺乳頭狀癌是安全可行的,但其遠期效果還有待長期隨訪觀察.
목적 탐토경흉유입로내경수술치료갑상선유두상암적가행성、유효성급안전성.방법 회고성분석2006년3월지2010년3월간절강대학의학원부속제이의원내경수술치료적85례갑상선유두상암환자적림상자료.결과 84례환자수술성공,평균수술시간113.3 min.84례균행중앙구청소,기중12례부의경측구림파결전이자가행환측경측구청소.평균청소림파결수목재중앙구위6.5개,재경측구위19.2개.6례(7.14%,6/84)출현술후잠시성성음시아,4례(4.76%,4/84)술후발생일과성저혈개증상.수방9~57개월,B초화ECT제시환측무잔류선체,국부무복발,경부외관량호,소유환자대수술효과균만의.결론 내경갑상선수술치료엄격선택적갑상선유두상암시안전가행적,단기원기효과환유대장기수방관찰.
Objective To evaluate the feasibility and safety of endoscopic thyroidectomy via anterior chest and breast for the treatment of patients with papillary thyroid carcinoma ( PTC ).Methods Endoscopic thyroidectomy was performed in 85 PTC patients between March 2006 and March 2010. Diagnosis was based on intraoprative frozen section. There were 83 females and 2 males, age averaged at 36. 3 years. Sixty three of 85 cases were diagnosed preoperatively as thyroid carcinoma and US revealed ipsilateral cervical lymph node enlargement suspective of metastasis in 12 cases. Endoscopic thyroidectomy plus selective neck dissection was performed. Results This procedure was carried out successfully in 84patients. There were 51 cases of papillary thyroid microcarcinomas(<1. 0 cm) , 28 cases between 1. 0 cm and<2. 0 cm, and 5 cases with the diameter between 2. 0 cm and 3. 0 cm. Total thyroidectomy, ispilateral lebectomy and ispilateral lebectomy plus contralateral subtotal lobetomy were performed in 4, 6, 74 cases,respectively. Central compartment dissection was performed in all of the 84 cases and ipsilateral neck dissection was also performed in 12 cases that were suspected metastatic lateral neck lymph nodes. The mean operative time was (113. 3 ±46. 5) minutes. No significant blood loss occurred. The mean number of lymph nodes yield in the central compartment and lateral compartment were 6. 5 (range 2 to 14) and 19. 2 (range 9 to 26 ), respectively. Forty-four cases ( 44/84, 52. 4% ) had metastatic lymph nodes in central compartment, while 11 cases (11/12,91.1% ) in lateral compartment. Six patients (6/84,7.14%) had transient vocal cord palsy and recovered after 1-2 months. Postoperative transient hypocalcaemia occurred in 4 cases (4. 8% ) , and there were no other major complications. The average postoperative hospital stay was 3. 7 days (range 3 to 6). No evidence of residual or recurrent disease was found at follow-up. The cosmetic results of this procedure were excellent. Conclusions The anterior chest and breast approach of endoscopic thyroidectomy is feasible and safe and cosmetic worthwhile for selected cases of PTC.