バセドウ病に対する内視鏡補助下甲状腺亜全摘術―手術手技と治療成績―

Video assisted subtotal thyroidectomy for Graves's disease ―Surgical procedures and clinical results―

◆要旨：バセドウ病に対する内視鏡補助下甲状腺亜全摘術の手術手技と治療成績を報告する．鎖骨下前胸部に加えた小斜切開創を操作孔とし，胸鎖乳突筋内縁で前頸筋と甲状腺被膜間を剥離し操作腔を作成．前頸筋をキルシュナー鋼線で吊り上げ操作腔を確保する．峡部を切離し，片葉亜全摘後，対側葉亜全摘を行う．ドレナージは行っていない．これまでに施行した58例の成績は，襟状切開手術と比較して約1.5倍の手術時間を要したが，術後経過に差はなく，頸部露出部に手術創がないことで患者の満足度は良好であった．内視鏡補助下甲状腺亜全摘術は，特殊な機器や装置を必要とせず，整容性の点からも優れており，有用な術式であると考えられた．

　Surgical procedures and clinical results of the video-assisted subtotal thyroidectomy for Graves's disease were reported. Using the small skin incision made on the anterior chest wall below the clavicle, we separated the strap muscles from the underlying thyroid gland. Working space was created by lifting up the strap muscles using Kirschner wire. After dissecting and dividing the isthmus from the trachea, subtotal thyroidectomy of each lobes was performed. No drainage was necessary. We performed this procedure to 58 patients, and comparing to the conventional surgery, this technique required longer surgical time.

　However, regarding the postoperative courses, there were no significant differences between the two procedures and the patients who underwent video-assisted procedure were satisfied because there was no operation scar on the neck. Video-assisted subtotal thyroidectomy which requires no special equipment and produces cosmetic advantages is an useful surgical procedure for Graves' disease.