中国微创外科杂志
中國微創外科雜誌
중국미창외과잡지
CHINESE JOURNAL OF MINIMALLY INVASIVE SURGERY
2015年
1期
22-25
,共4页
周京安%贺建业%伍冀湘%李洋
週京安%賀建業%伍冀湘%李洋
주경안%하건업%오기상%리양
腔镜辅助甲状腺微创手术%整块切除%甲状腺微小乳头状癌%中央区淋巴结清扫
腔鏡輔助甲狀腺微創手術%整塊切除%甲狀腺微小乳頭狀癌%中央區淋巴結清掃
강경보조갑상선미창수술%정괴절제%갑상선미소유두상암%중앙구림파결청소
Minimally invasive video-assisted thyroidectomy%En-bloc resection%Papillary thyroid microcarcinoma%Central lymph node dissection
目的：探讨整块与分块切除在腔镜辅助甲状腺微小乳头状癌手术中的应用效果。方法回顾性分析2013年2月～2014年2月北京安贞医院腔镜辅助手术中快速冰冻病理证实甲状腺微小乳头状癌患者62例资料，前24例先行患侧腺叶、峡部切除，继而在纳米碳示踪下行中央区淋巴结分块清扫（分块切除组），后38例将患侧腺叶、峡部、中央区淋巴脂肪组织连续整块切除一次完成（整块切除组）。对2组手术时间、术中出血量、中央区淋巴结清扫数量、术后并发症情况进行比较。结果2组手术均顺利完成，无中转开放手术。整块切除组较分块切除组手术时间长[（86．1±10．0）min vs ．（73．5±8．9） min，t＝4．997，P＝0．000]，2组术中出血量差异无显著性（P＞0．05），而中央区淋巴结清扫数量整块切除组明显多于分块切除组[（8．2±1．6）枚vs．（6．1±1．5）枚，t＝5．131，P＝0．000]。2组均无永久性喉返神经损伤及低钙血症。术后暂时性声音嘶哑整块切除组3例，分块切除组4例，总发生率为11．3％（7／62），2组间差异无显著性（χ2＝0．424，P＝0．515），未予特殊处理，均于术后8周内恢复正常。术后随访5～17个月，平均10个月，均无局部种植、复发和远处转移。结论整块切除较分块切除更符合无瘤原则，在腔镜辅助甲状腺微小乳头状癌手术中可以得到安全的应用。
目的：探討整塊與分塊切除在腔鏡輔助甲狀腺微小乳頭狀癌手術中的應用效果。方法迴顧性分析2013年2月～2014年2月北京安貞醫院腔鏡輔助手術中快速冰凍病理證實甲狀腺微小乳頭狀癌患者62例資料，前24例先行患側腺葉、峽部切除，繼而在納米碳示蹤下行中央區淋巴結分塊清掃（分塊切除組），後38例將患側腺葉、峽部、中央區淋巴脂肪組織連續整塊切除一次完成（整塊切除組）。對2組手術時間、術中齣血量、中央區淋巴結清掃數量、術後併髮癥情況進行比較。結果2組手術均順利完成，無中轉開放手術。整塊切除組較分塊切除組手術時間長[（86．1±10．0）min vs ．（73．5±8．9） min，t＝4．997，P＝0．000]，2組術中齣血量差異無顯著性（P＞0．05），而中央區淋巴結清掃數量整塊切除組明顯多于分塊切除組[（8．2±1．6）枚vs．（6．1±1．5）枚，t＝5．131，P＝0．000]。2組均無永久性喉返神經損傷及低鈣血癥。術後暫時性聲音嘶啞整塊切除組3例，分塊切除組4例，總髮生率為11．3％（7／62），2組間差異無顯著性（χ2＝0．424，P＝0．515），未予特殊處理，均于術後8週內恢複正常。術後隨訪5～17箇月，平均10箇月，均無跼部種植、複髮和遠處轉移。結論整塊切除較分塊切除更符閤無瘤原則，在腔鏡輔助甲狀腺微小乳頭狀癌手術中可以得到安全的應用。
목적：탐토정괴여분괴절제재강경보조갑상선미소유두상암수술중적응용효과。방법회고성분석2013년2월～2014년2월북경안정의원강경보조수술중쾌속빙동병리증실갑상선미소유두상암환자62례자료，전24례선행환측선협、협부절제，계이재납미탄시종하행중앙구림파결분괴청소（분괴절제조），후38례장환측선협、협부、중앙구림파지방조직련속정괴절제일차완성（정괴절제조）。대2조수술시간、술중출혈량、중앙구림파결청소수량、술후병발증정황진행비교。결과2조수술균순리완성，무중전개방수술。정괴절제조교분괴절제조수술시간장[（86．1±10．0）min vs ．（73．5±8．9） min，t＝4．997，P＝0．000]，2조술중출혈량차이무현저성（P＞0．05），이중앙구림파결청소수량정괴절제조명현다우분괴절제조[（8．2±1．6）매vs．（6．1±1．5）매，t＝5．131，P＝0．000]。2조균무영구성후반신경손상급저개혈증。술후잠시성성음시아정괴절제조3례，분괴절제조4례，총발생솔위11．3％（7／62），2조간차이무현저성（χ2＝0．424，P＝0．515），미여특수처리，균우술후8주내회복정상。술후수방5～17개월，평균10개월，균무국부충식、복발화원처전이。결론정괴절제교분괴절제경부합무류원칙，재강경보조갑상선미소유두상암수술중가이득도안전적응용。
Objective To explore the application effects between en-bloc resection and piecemeal resection of papillary thyroid microcarcinoma ( PTMC) in minimally invasive video-assisted thyroidectomy ( MIVAT) . Methods We made a retrospective analysis in this clinical study.During the period between February 2013 and February 2014, 62 cases with PTMC were confirmed by the intra-operative fast frozen section examination in this hospital.The former 24 cases underwent piecemeal central lymph node dissection ( CLND ) clearance after ipsilateral lobectomy plus isthmusectomy with the lymphatic tracing of carbon nanoparticles ( piecemeal resection group) .The latter 38 cases underwent continuous en-bloc resection with ipsilateral lobectomy plus isthmusectomy and CLND at a time ( en-bloc resection group) .The operative time, intra-operative blood loss, number of dissected central lymph nodes, and post-operative complications were compared. Results All the procedures were accomplished successfully, without conversion to conventional thyroidectomy.The en-bloc resection group experienced a longer operative time than the piecemeal resection group [(86.1 ±10.0) min vs.(73.5 ±8.9) min, t=4.997, P=0.000].There was no difference in the intra-operative blood loss between the two groups (P>0.05).The number of dissected central lymph nodes in the en-bloc resection group was more than that in the piecemeal resection group [(8.2 ±1.6) nodes vs.(6.1 ±1.5) nodes, t=5.131, P=0.000].There was no recurrent laryngeal nerve ( RLN) everlasting injury and hypocalcemia.However, transient hoarseness was still inevitable, with 4 and 3 cases respectively, reaching an overall mobidity rate of 11.3% (7/62).There was no statistical difference between the two groups (χ2 =0.424,P=0.515) .Without any treatment, the hoarseness recovered gradually within post-operative 8 weeks.All the patients were followed up for 5-17 months ( mean, 10 months) .Neither loco-regional reccurence nor distant metastasis was observed. Conclusion Preliminary impression emerging from this study seems to suggest that en-bloc resection more conforms to non-tumor principle than piecemeal resection, and can be safely applied in the operation of MIVAT for PTMC.
