PDF(Pubmed)
Abstract：
Remote-access thyroidectomy (RAT) is becoming a more frequently used approach that can avoid scars in the neck and provide better cosmetic results than open surgery. However, there has been no surgical indication for RAT in patients who have a history of cervical treatment (surgery or irradiation), and the use of RAT has been avoided in such patients. Here, we report a case in which a remote-access endoscopic hemithyroidectomy and central lymph node dissection by the anterior chest approach was successfully performed in a patient with papillary thyroid carcinoma (a 77-year-old Japanese male) after he had undergone ipsilateral cervical radiation therapy to parotid gland cancer (mucoepidermoid carcinoma) thirteen years earlier. Regarding trocar insertion, a 30-mm skin incision was made in the left anterior chest approx. 5 cm below the clavicle. Two 5-mm trocars were inserted through the 30-mm incision. We then insufflated with carbon dioxide to 6 mmHg. One additional 5-mm trocar was placed cephalad to the 30-mm incision. When we performed this RAT, we detected no effect of the prior irradiation. To the best of our knowledge, this is the first report of RAT after irradiation. The cosmetic outcome of RAT is clearly superior, and the present case demonstrates that a RAT can be safely performed in carefully selected patients even after irradiation.
摘要：
远程访问甲状腺切除术（RAT）正在成为一种更常用的方法，可以避免颈部疤痕，并提供比开放手术更好的美容效果。然而,有宫颈治疗史（手术或放疗）的患者没有RAT的手术指征，并且在此类患者中避免使用RAT。这里,我们报道了一例病例,在1例甲状腺乳头状癌患者(一名77岁的日本男性)13年前接受了腮腺腺癌(粘液表皮样癌)同侧颈部放疗后,成功进行了远程进入内镜下半甲状腺切除术和胸前入路中央区淋巴结清扫术.关于套管针插入,在左前胸部做了一个30毫米的皮肤切口。5厘米以下的锁骨。通过30毫米切口插入两个5毫米套管针。然后我们用二氧化碳吹入到6mmHg。将另一个5毫米套管针放置在30毫米切口的头部。当我们表演这种老鼠的时候，我们没有检测到先前照射的影响。据我们所知,这是首次报道的RAT辐照后。RAT的美容结果明显优越，目前的情况表明，即使在照射后，RAT也可以在精心选择的患者中安全地进行。
