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经过20年的发展,腔镜甲状腺切除术适应证已经扩展至分化型甲状腺癌,尤其是甲状腺微小乳头状癌(PTMC)。术前评估是关键,评估的重点是原发肿瘤的位置以及转移淋巴结的大小、位置;腔镜PTMC手术关键是如何保护喉返神经(RLN)及甲状旁腺的功能。对于初学者,或遇到喉不返神经,或二次手术的时候,术中神经监测有明显的优势。对于PTMC病人,近全甲状腺切除术代替全切除术是防止甲状旁腺永久性损伤的有效术式。目前,对于PTMC行腔镜甲状腺手术治疗,在手术入路选择及淋巴结清扫范围等方面还存在争议。
After 20 years of development, endoscopic thyroidectomy indications have been extended to differentiated thyroid cancer, especially thyroid papillary carcinoma (PTMC). Preoperative evaluation is the key. The assessment focuses on the location of the primary tumor and the size and location of the metastatic lymph nodes. The key to endoscopic PTMC surgery is how to protect the RLN and parathyroid glands. For beginners, or encounter laryngeal nerve, or secondary surgery, intraoperative nerve monitoring has obvious advantages. In patients with PTMC, total thyroidectomy instead of total resection is to prevent permanent paralysis of the effective surgical procedures. At present, there is still controversy about the surgical treatment of PTTH for thyroidectomy, the choice of surgical approach and the range of lymph node dissection.