Minimally invasive thyroidectomy in the treatment of well differentiated thyroid cancers: indications and limits
Minimally invasive thyroidectomy in the treatment of well differentiated thyroid cancers: indications and limits
复制标题
DOI：
10.1097/moo.0b013e3283378239
复制
发表时间：
2010-04-01
影响因子：
1.6
通讯作者：
Berti, Piero
中科院分区：
文献类型：
--
作者：
Miccoli, Paolo;Materazzi, Gabriele;Berti, Piero
综述目的总结最近有关微创甲状腺切除术的文献，并讨论内镜/视频辅助治疗分化型甲状腺癌的适应症和局限性。 最新发现20世纪90年代，随着微创手术的普遍发展趋势，内镜方法被应用于颈部手术中甲状旁腺切除术和甲状腺切除术。应用最广泛的微创甲状腺切除技术是微创视频辅助甲状腺切除术（MIVAT）。摘要乳头状癌是 MIVAT 的主要适应症，这种癌症通常见于年轻女性的正常腺体。相反，对于局部浸润性癌、淋巴结转移或两者兼而有之，必须立即将手术转换为传统技术。 MIVAT 也不适用于治疗髓样癌和未分化癌。最近的前瞻性随机研究清楚地表明，在处理“低风险”乳头状癌时，MIVAT 可以在甲状腺床水平实现相同的清除率，并获得与传统技术相同的结果。同时，患者可以受益于这种微创技术的主要优点：术后疼痛更少、术后恢复更快以及良好的美容效果。
Purpose of reviewTo summarize recent papers in the literature with respect to minimally invasive thyroidectomy and discuss indications and limits of the endoscopic/video-assisted treatment of differentiated thyroid carcinoma.Recent findingsDuring the 1990s, with the general tendency to develop minimally invasive operations, an endoscopic approach was applied to neck surgery for both parathyroidectomy and thyroidectomy. The most wide spread minimally invasive technique for thyroidectomy is minimally invasive video-assisted thyroidectomy (MIVAT).SummaryPapillary carcinoma is the main indication for MIVAT, this cancer usually being found in normal glands of young women. In contrast, for locally invasive carcinomas, lymph node metastasis or both, the procedure must be immediately converted to the conventional technique. MIVAT also is not indicated for the treatment of medullary and anaplastic carcinomas. Recent prospective randomized studies clearly demonstrate that MIVAT allows the same clearance to be achieved at the thyroid bed level and the same outcome as with the conventional technique, when dealing with 'low-risk' papillary carcinoma. At the same time, patients can benefit from the main advantages of this minimally invasive technique: less postoperative pain, faster postoperative recovery and excellent cosmetic outcome.