腋窩アプローチ法による内視鏡下良性甲状腺腫手術

Endoscopic thyroidectomy by the axillary approach

◆要旨：甲状腺疾患に内視鏡下手術が導入されて以来，多種多様の手術術式が考案されてきた．筆者らも1999年に腋窩アプローチ法による内視鏡下甲状腺手術を6cm程度までの良性甲状腺結節，バセドー病，低リスク甲状腺微小癌に行ってきた．7例の甲状腺癌を含む122例で甲状腺切除を完遂し，開放手術への移行が必要であった例は3例であった．術中出血を2例経験したが，止血し甲状腺切除を完遂した．甲状腺葉切除の平均手術時間は155分で，一過性の反回神経麻痺を3例，腕痛を1例に認めた．整容性は非常に優れており，ほとんどすべての患者が満足していた．適応には限界があるが，非常に有効な術式であると思われる．

　Minimally invasive surgery is widely employed for the treatment of thyroid diseases. We have performed pure endoscopic thyroidectomy by the axillary approach from 1999. In this study, we evaluate the efficacy of this surgical procedure. The indications for this procedure included the presence of a benign thyroid nodule with a maximum diameter of less than 6 cm as observed during a preoperative ultrasonography examination, Graves' disease and small low-risk papillary thyroid carcinomas. Our procedure is pure endoscopic thyroidectomy with carbon dioxide insufflation from an axillary portion. This procedure was performed in 122 patients, 7 of whom had papillary thyroid carcinomas. Conversion was necessary in 3 patients. Thyroid partial recection was successfully accomplished in 21 patients, thyroid lobectomy in 93 patients and subtotal thyroidectomy for 5 patients with Graves' disease. Unilateral central neck lymph node dissection was completed in 7 patients without any complications. Major vessel bleeding during surgery was experienced in 2 patients, however, these complications were controlled by endoscopic procedure. The mean operative time for thyroid lobectomy was 155 minutes. Postoperative complications included 3 transient recurrent nerve palsies, and 1 postoperative arm pain. The cosmetic result was excellent and almost all patients were satisfied with the results. Indications for pure endoscopic thyroidectomy are still limited. Nonetheless, in selected patients including low risk small papillary carcinoma, it seems a valid option for thyroidectomy and even preferable to conventional surgery because of its significant advantages, especially in terms of cosmetic result.