Hybrid-type endoscopic thyroidectomy (HET: Tori's method) for differentiated thyroid carcinoma including invasion to the trachea.
Hybrid-type endoscopic thyroidectomy (HET: Tori's method) for differentiated thyroid carcinoma including invasion to the trachea.
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DOI：
10.1007/s00464-013-3245-4
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发表时间：
2014-03
影响因子：
3.1
通讯作者：
Tori, Masayuki
中科院分区：
文献类型：
--
作者：
Tori, Masayuki
关键词：
内镜甲状腺切除术（ET）或机器人甲状腺切除术尚未应用于侵犯气管的甲状腺癌和广泛的淋巴结转移。另一方面，小切口甲状腺切除术缺乏足够的工作空间和清晰的视野。作者新开发的混合型内窥镜甲状腺切除术（HET），以克服这些问题。2011年3月至2012年2月，对85例患者进行了HET。分析其临床病理特征。为了评价HET治疗恶性肿瘤的优越性，将1年前进行的传统肺叶切除术和中央室淋巴结清扫术（CCND）与HET进行了比较。在肺叶切除术和淋巴结清扫术中，在锁骨上方做一个皮肤切口（1.5 cm），在锁骨下方3 cm做一个端口切口（5 mm）。然后通过抬高峡部直接通过切口进行CCND。为了获得足够的工作空间进行肺叶切除术，带状肌肉被绑住并拉向头部，然后挂在摇篮上。用牵开器将甲状腺叶牵拉至中线，然后在内窥镜监视器下分离喉下神经并切断甲状腺下血管。如有必要，可同时进行外侧淋巴结清扫。在甲状腺全切除术中，在对侧进行相同的手术。手术刀可以用来刮通过每个切口的情况下，气管入侵。其中恶性62例，包括甲状腺乳头状癌（PTC），良性23例。22例行甲状腺全切除术，49例行CCND术。对8例患者进行了气管侵入剃毛。术后1-2年无死亡、并发症、复发及转移。与传统甲状腺切除术相比，HET在失血量、视觉模拟评分和术后住院时间方面具有上级优势。作者的方法（Tori的方法）可能是创伤小，美容效果好，而且是安全可行的分化型甲状腺癌，包括侵犯气管。
Endoscopic thyroidectomy (ET) or robotic thyroidectomy is yet to be applied to thyroid carcinoma invasive to the trachea and to wide lymph node node metastasis. On the other hand, small-incision thyroidectomy lacks sufficient working space and clear vision. The author has newly developed hybrid-type endoscopic thyroidectomy (HET) to overcome these problems. From March 2011 to February 2012, HET was performed for 85 patients. Clinicopathologic characteristics were analyzed. To evaluate the superiority of HET for malignancy representatively, conventional lobectomy with central compartment node dissection (CCND) performed 1 year previously was compared with HET. In lobectomy and node dissection, a single skin incision (1.5 cm) is made above the clavicle, with a port incision (5 mm) made 3 cm below the clavicle. Then CCND is performed directly through the incision by lifting up the isthmus. To obtain sufficient working space for the lobectomy, the strap muscles are taped and pulled toward the head, then hung by the cradle. The thyroid lobe is retracted to the midline with a retractor, followed by isolation of the inferior laryngeal nerve and transection of the inferior thyroid vessels with the monitor of the scope. Lateral lymph nodes dissection can be performed at the same time, if necessary. In total thyroidectomy, the same procedure is performed at the opposite side. The scalpel can be used to shave through each incision in case of tracheal invasion. Of the 85 cases, 62 were malignant, involving papillary thyroid carcinoma (PTC), and 23 were benign. Total thyroidectomy was performed for 22 of the PTC cases and CCND for 49 of the cases. Shaving for tracheal invasion was performed for eight patients. No mortality, complications, recurrence, or metastasis was found 1–2 years after the operation. Compared with conventional thyroidectomy, HET was superior in blood loss, visual analog scale, and postoperative hospital stay. The author’s method (Tori’s method) might be less invasive, cosmetically excellent, and moreover, safe and feasible for differentiated thyroid carcinoma including invasion to the trachea.
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DOI：
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