CAJ | 학술논문

目的探讨经胸前入路无注气内镜手术治疗早期甲状腺乳头状癌(T1N0M0)的安全性和可行性.方法 2004年7月至2010年12月,收集应用经胸前入路无注气内镜手术治疗91例甲状腺乳头状癌(T1N0M0)患者,对肿瘤大小、手术类型、手术时间、手术出血量、术后并发症、术后平均住院时间等临床因素进行总结分析.结果 91例患者均成功进行内镜手术,无一例中转开放手术,肿瘤平均((x)±s,下同)直径为(0.96±0.71 )cm,41例患者行单侧腺叶切除,3例行单侧腺叶次全切除,42例行单侧腺叶切除+对侧腺叶次全切除,5例行双侧腺叶切除.39例甲状腺微小癌(肿瘤直径＜1.0 cm)患者行中央区淋巴清扫术,29例甲状腺癌(肿瘤直径1.0～2.0 cm)患者行中央区淋巴清扫术,其中2例同时行择区性颈淋巴清扫术.平均手术时间为(99±17)min,手术出血量为(18±12)ml,术后平均住院日为(3±1)d.2例患者术后出现暂时性喉返神经麻痹,均在术后1～2个月内恢复,1例出现永久性喉返神经麻痹,暂时性低钙血症2例,无喉上神经损伤、气管损伤、皮下气肿、术后血肿、顽固性咳嗽.所有患者颈前未遗留手术瘢痕,对术后美容效果满意.术后随访7～ 85个月,平均(58.4±17.2)个月,未见肿瘤复发.结论经胸前入路无注气内镜手术治疗早期甲状腺乳头状癌近期疗效安全可行,术后美容效果好,远期疗效尚待进一步随访观察.
목적 탐토경흉전입로무주기내경수술치료조기갑상선유두상암(T1N0M0)적안전성화가행성.방법 2004년7월지2010년12월,수집응용경흉전입로무주기내경수술치료91례갑상선유두상암(T1N0M0)환자,대종류대소、수술류형、수술시간、수술출혈량、술후병발증、술후평균주원시간등림상인소진행총결분석.결과 91례환자균성공진행내경수술,무일례중전개방수술,종류평균((x)±s,하동)직경위(0.96±0.71 )cm,41례환자행단측선협절제,3례행단측선협차전절제,42례행단측선협절제+대측선협차전절제,5례행쌍측선협절제.39례갑상선미소암(종류직경＜1.0 cm)환자행중앙구림파청소술,29례갑상선암(종류직경1.0～2.0 cm)환자행중앙구림파청소술,기중2례동시행택구성경림파청소술.평균수술시간위(99±17)min,수술출혈량위(18±12)ml,술후평균주원일위(3±1)d.2례환자술후출현잠시성후반신경마비,균재술후1～2개월내회복,1례출현영구성후반신경마비,잠시성저개혈증2례,무후상신경손상、기관손상、피하기종、술후혈종、완고성해수.소유환자경전미유류수술반흔,대술후미용효과만의.술후수방7～ 85개월,평균(58.4±17.2)개월,미견종류복발.결론 경흉전입로무주기내경수술치료조기갑상선유두상암근기료효안전가행,술후미용효과호,원기료효상대진일보수방관찰.
Objective To evaluate the feasibility and safety of endoscopic thyroidectomy via anterior chest approach for early papillary thyroid cancer(T1N0M0).Methods From July 2004 to December 2010,91 patients with early papillary thyroid cancer underwent minimally invasive endoscopic thyroidectomy via anterior chest approach.The clinical and pathologic characteristics of patients,operation types,operative time,postoperative hospital stay time,and postoperative complications were analyzed retrospectively.Results All 91 operations were successfully performed endoscopically.There was no case conversed to open surgery.The mean tumor size was (0.96 ± 0.71 ) cm.The operation types included unilateral lobectomy (41 cases),unilateral subtotal lobectomy (3cases),ipsilateral lobectomy and contralateral subtotal lobectomy (42 cases),and bilateral total thyroidectomy (5 cases).Central compartment node dissection was carried out in 39 cases with the tumor diameter less than 1.0 cm and in 29 cases with the tumor diameter of 1.0-2.0 cm.The mean operating time was (99 ± 17) min,the mean bleeding volume was (18 ± 12) ml,and the mean post-operative hospital stay time was (3 ± 1 ) days.Temporary recurrent laryngeal nerve ( RLN),paresis occurred in 2 cases and recovered within 1 to 2 months after the surgery.One patient showed permanent RLN paralysis.Two patients showed temporary hypoparathyroidism.No patient showed post-operative seroma and tracheal injury.There was no case with injury to the superior laryngeal nerve.No further complications,such as irritating cough,tetany,and emphysema developed after the operation.With the anterior chest wall approach,all patients had no surgical scar on the neck and thus they were satisfied with the cosmetic outcomes.All patients were disease free by follow-up of 7 to 85 (58.4 ± 17.2) months.Conclusions Minimally invasive endoscopic thyroid surgery through anterior chest approach is a feasible and safe method for the treatment of early papillary thyroid cancer.This technique had better cosmetic results and the long-term effect of this technique needs further evaluation.