Objective To evaluate the feasibility and safety of endoscopic thyroidectomy via anterior chest approach for early papillary thyroid cancer(T1N0M0).Methods From July 2004 to December 2010,91 patients with early papillary thyroid cancer underwent minimally invasive endoscopic thyroidectomy via anterior chest approach.The clinical and pathologic characteristics of patients,operation types,operative time,postoperative hospital stay time,and postoperative complications were analyzed retrospectively.Results All 91 operations were successfully performed endoscopically.There was no case conversed to open surgery.The mean tumor size was (0.96 ± 0.71 ) cm.The operation types included unilateral lobectomy (41 cases),unilateral subtotal lobectomy (3cases),ipsilateral lobectomy and contralateral subtotal lobectomy (42 cases),and bilateral total thyroidectomy (5 cases).Central compartment node dissection was carried out in 39 cases with the tumor diameter less than 1.0 cm and in 29 cases with the tumor diameter of 1.0-2.0 cm.The mean operating time was (99 ± 17) min,the mean bleeding volume was (18 ± 12) ml,and the mean post-operative hospital stay time was (3 ± 1 ) days.Temporary recurrent laryngeal nerve ( RLN),paresis occurred in 2 cases and recovered within 1 to 2 months after the surgery.One patient showed permanent RLN paralysis.Two patients showed temporary hypoparathyroidism.No patient showed post-operative seroma and tracheal injury.There was no case with injury to the superior laryngeal nerve.No further complications,such as irritating cough,tetany,and emphysema developed after the operation.With the anterior chest wall approach,all patients had no surgical scar on the neck and thus they were satisfied with the cosmetic outcomes.All patients were disease free by follow-up of 7 to 85 (58.4 ± 17.2) months.Conclusions Minimally invasive endoscopic thyroid surgery through anterior chest approach is a feasible and safe method for the treatment of early papillary thyroid cancer.This technique had better cosmetic results and the long-term effect of this technique needs further evaluation.%目的 探讨经胸前入路无注气内镜手术治疗早期甲状腺乳头状癌(T1N0M0)的安全性和可行性.方法 2004年7月至2010年12月,收集应用经胸前入路无注气内镜手术治疗91例甲状腺乳头状癌(T1N0M0)患者,对肿瘤大小、手术类型、手术时间、手术出血量、术后并发症、术后平均住院时间等临床因素进行总结分析.结果 91例患者均成功进行内镜手术,无一例中转开放手术,肿瘤平均((x)±s,下同)直径为(0.96±0.71 )cm,41例患者行单侧腺叶切除,3例行单侧腺叶次全切除,42例行单侧腺叶切除+对侧腺叶次全切除,5例行双侧腺叶切除.39例甲状腺微小癌(肿瘤直径＜1.0 cm)患者行中央区淋巴清扫术,29例甲状腺癌(肿瘤直径1.0～2.0 cm)患者行中央区淋巴清扫术,其中2例同时行择区性颈淋巴清扫术.平均手术时间为(99±17)min,手术出血量为(18±12)ml,术后平均住院日为(3±1)d.2例患者术后出现暂时性喉返神经麻痹,均在术后1～2个月内恢复,1例出现永久性喉返神经麻痹,暂时性低钙血症2例,无喉上神经损伤、气管损伤、皮下气肿、术后血肿、顽固性咳嗽.所有患者颈前未遗留手术瘢痕,对术后美容效果满意.术后随访7～ 85个月,平均(58.4±17.2)个月,未见肿瘤复发.结论 经胸前入路无注气内镜手术治疗早期甲状腺乳头状癌近期疗效安全可行,术后美容效果好,远期疗效尚待进一步随访观察.
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