バセドウ病に対する内視鏡下甲状腺亜全摘術

Endoscopic subtotal thyroidectomy for Graves' disease

◆要旨：甲状腺良性疾患は女性に多く，特にバセドウ病は若年者に多いことから，わが国では整容性を重視し，頸部に手術創を残さない種々のアプローチ法による内視鏡下甲状腺切除術が考案されてきた．筆者らが行っている乳房アプローチ法による完全内視鏡下甲状腺切除術の利点は，最小の創から内視鏡の挿入位置やトロッカー数を変えずに，甲状腺両葉の操作ができる点である．さらに術野が解剖学的に理解しやすく，バセドウ病手術に適している．乳房アプローチ法による内視鏡下甲状腺亜全摘術は，前胸部から前頸部に手術操作腔を作製する必要があるが，安全に実施でき，患者の整容的な満足度が高い有用な術式である．

　Benign thyroid diseases, especially Graves'd isease which is more common in younger patients, are more frequent in females. In Japan, therefore, various approaches have been studied in order not to leave any undesirable scar on the neck and as a result, endoscopic thyroidectomy developed. The merit of total endosocpic thyroidectomy by the breast approach is the minimal operative wound without having to change the endoscope insertion site or the number of trocars when manipulating both thyroid lobes. Furthermore, the visual field is easy for the understanding of the anatomy, making the procedure suitable for Graves' disease surgery. Endoscopic subtotal thyroidectomy by the breast approach differs greatly from the conventional approaches in that it requires creation of a subcutaneous working space. However, our operation for patients with Graves' disease is a safe and effective procedure that allows a high level of cosmetic satisfaction.