以內視鏡輔助之微創性甲狀腺切除術治療甲狀腺腫瘤

Endoscope-assisted Minimally Invasive Thyroidectomy for Thyroid Tumors

陳志明(Chih-Ming Chen) ； 陳穆寬(Mu-Kuan Chen) ； 張正權(Cheng-Chuan Chang)

《台灣耳鼻喉頭頸外科雜誌》 38卷3期 (2003/06) Pp. 95-101

https://doi.org/10.6286/2003.38.3.95

摘要

背景：利用內視鏡影像攝影系統的幫助來施行微創性手術在外科系的應用已相當積極，但在耳鼻喉科則主要局限於鼻部的手術。在病人對頭頸部傷口大小與美觀越來越苛求下，本研究乃嘗試發展經由內視鏡影像系統所提供的清晰放大視野來切除甲狀腺腫瘤，期使手術的傷口更小、並減少手術併發症的產生；且期望籍由技術的純熟，來了解內視鏡輔助性甲狀腺切除術的適用範圍，更進一步找出其標準的手術步驟。
方法：自2002年2月至2002年9月共有24名病患接受內視鏡甲狀腺切除術，男性6名、女性18名，年齡介於26歲至76歲間，平均年齡47歲；手術皆採全身麻醉，先於下頸部沿皮膚皺摺切開2~3cm的傷口，掀起皮瓣並將帶狀肌(strap muscles)從中線分開，勾開肌肉以露出甲狀腺；沿甲狀腺被膜周圍剝離附近鬆散的組織，直接在肉眼下定位喉返神經；有必要時在內視鏡輔助下分出甲狀上動脈、靜脈，用血管夾(hemoclip)結紮後以超音波刀(harmonic scalpel)燒斷；小心將神經與腺體分開後以超音波刀作甲狀腺腫瘤切除。
結果：24名病患中有3例施行雙側甲狀腺手術，21例施行單側手術；手術時間平均2.1±0.65小時，傷口平均大小2.8±0.5cm，無因遭遇困難而轉變成傳統術式之病例。檢體最大6.5×6.0×3.0cm，平均4.0×2.7×1.7cm；術後病理檢查結果得到良性結節19例、發炎3例、冷凍切片良性而永久切片發現內含惡性者2例，此2例之後分別接受甲狀腺全切除。住院天數均為3天，除1例疑為暫時性損傷喉上神經外，無聲帶麻痺、血腫、或其他併發症產生。
結論：相較於傳統的手術方法，內視鏡輔助性甲狀腺切除術除了手術時間較長，其餘成績都相當令人滿意，相信假以時日在更適切的輔助器具發展出來後，或許能成為耳鼻喉科醫師在治療甲狀腺腫瘤除傳統手術外的另一種不錯選擇。

關鍵字

內視鏡輔助性甲狀腺切除術 ； 內視鏡 ； 甲狀腺切除術 ； 微創性

並列摘要

BACKGROUND: Minimally invasive endoscopic thyroidectomy reduces the extent of scarring compared to traditional cervicotomy. We developed an endoscope-assisted thyroidectomy (EAT) procedure that requires only a single small lower neck incision and evaluated its effectiveness in a series of patients.
METHODS: From February 2002 to September 2002, 24 patients with thyroid nodules were enrolled into this study. Using a harmonic scalpel under endoscopic assistance, the tumors were approached through a 20 to 30 mm transverse skin wound. The feasibility of this procedure was evaluated and post-operative complications were recorded.
RESULTS: The 24 patients included 6 males and 18 females with an age range from 26 to 76 years old. Thyroid surgery was unilateral in 21 patients and bilateral in three patients. The mean operation time was 2.1 ± 0.65 hours. The procedure was successful without conversion to traditional cervicotomy in all patients. The average size of the tumor was 4.0×2.7×1.7cm. The final pathologic diagnosis was benign nodule in 19 patients, thyroiditis in 3 patients and papillary cancer embedded in benign goiter in 2 patients, both of whom received total thyroidectomy later. Post-operative complication was rare. Only one patient had a transient superior laryngeal nerve injury in this series and this condition resolved within one week postoperatively.
CONCLUSION: EAT allows safe removal of thyroid tumor with acceptable cosmesis. It is an attractive option for patients requiring surgical treatment of thyroid diseases.

並列關鍵字

endoscope-assisted thyroidectomy ； endoscope ； thyroidectomy ； minimally invasive