甲状腺乳頭癌に対する内視鏡補助下甲状腺切除＋頸部リンパ節D2郭清

Video-assisted thyroidectomy and modified radical neck dissection for the papillary thyroid carcinoma

◆要旨：甲状腺乳頭癌に対し内視鏡補助下に甲状腺切除D2郭清を行っている．襟状切開正中やや患側よりに1.5～2.0cmの皮切，前頸筋群を正中で分け入り甲状腺に達する．創縁保護のためシリコン製のリングをボタン式にはめ込み，筋鉤で吊り上げ内視鏡補助下に手術操作を行う．初めに内視鏡補助下に甲状腺切除，気管周囲を郭清する．続いて側方郭清はまず血管鞘を開き，総頸動脈，迷走神経を内側へ圧排する．後頸筋膜より浅側にある脂肪織を，包んでいる膜を破らず一塊として正中側へ引き出し，超音波メスで切離することによりV，VIを郭清する．術後の創部は美容的に優れており，創周囲の癒着による嚥下時違和感や筋萎縮も少なく，患者の満足度も高い．

　We have performed video-assisted thyroidectomy and modified radical neck dissection for papillary thyroid carcinoma. From the small skin incision, the strap muscles were divided at the center and the thyroid was exposed.

　In order to protect the wound, the edge of it was covered by a silicon ring. The skin and the muscles were then lifted up by the hook and the small plate.

　First, the thyroid was removed, and next, the lymph nodes around the trachea were dissected through video or direct view. For the dissection of the lymph nodes of lateral area, the vascular sheath of the common carotid artery and the internal jugular vein were opened through the video view.

　Both the vessels and the vagus nerve were divided, and the fatty tissue including the lymph nodes that was between the vessels and the vagus nerve was then pulled out.

　HARMONIC SCALPEL（ETHICON END-SURGERY）or ULTRA SHEARS（Auto Suture）was used for most of the procedures.

　All patients had only a small wound and were satisfied because there was no discomfort due to skin adhesion or muscle atrophy.