Dr. David J Terris, Porubsky 是该中心耳鼻喉科学MCG 部门的教授和系主任,头脖部手术专家和论文主要作者。他介绍说 "我们先用自动牵开器让甲状腺体曝露, 然后我们借用刚好可伸进小切口的显微放大镜和腹腔镜等其他器械 使随后的手术能通过影像屏幕进行, Dr. Terris说 由于手术切口小,他可以在手术当天就送病人回家。
"这一方法真是太好了," Dr. Terris说: "它给我们怎么处理这些患者的手法带来完全是革命性的改变。 更重要的事是, 我们通常在年轻妇女中做这样的切除术。 她们最关心术后对她们外表形象的变化。"女性比男性更容易患良性甲状腺结节和甲状腺癌; 44 名被调查的患者就有31位是妇女, Dr. Terris 认为 女性患者的现实需求促使他探索创伤性更小的手术改进。"Dr. Terris 和他的同事在论文中还强调:”这种方法是对现代内分泌外科医生实践的改良和适宜的补充。”,
New approach to thyroid surgery reduces incision size
An incision about half the length used for traditional surgery works just as well in removing diseased thyroids, researchers have found.
This minimally invasive approach is safe, likely speeds wound healing and has a superior cosmetic result, according to findings published in the June issue of Laryngoscope. The study looked at 44 patients with cancerous or benign thyroid disease who had surgery between September 2003 and May 2004 at Medical College of Georgia Medical Center or the Veterans Affairs Medical Center in Augusta. "This is a very straightforward approach in skilled hands that allows us to use smaller incisions while still safely identifying important structures in the area, which are the nerves to the voice box and the parathyroid glands," says Dr. David J. Terris, Porubsky Professor and chair of the MCG Department of Otolaryngology - Head and Neck Surgery and lead author on the study. This approach incorporates various techniques to reduce the typical incision size across the base of the neck - from about three to four inches to one to two inches - while still enabling removal of all or part of the peach-sized gland that controls metabolism. Growths on this gland can cause jitters and weight loss.
"We use retractors to get exposure and use telescopes and other laparoscopic instruments that can fit through a small incision then we work off the video screen," says Dr. Terris. "I send many patients home the day of surgery because it's so much less invasive." To access the thyroid, most otolaryngologists make a horizontal incision at the base of neck, called a transverse cervical collar incision, move the muscles and dissect out the thyroid. This approach remains the best option for some patients who have had previous surgery or have an extremely enlarged thyroid. But most patients - 65 percent of the 44 patients in the study - likely can benefit from a smaller, more direct approach, Dr. Terris says. He notes that working through the smaller space increases surgery time about 20-30 percent, but that has not been a deterrent for his patients.
The minimally invasive approach includes a smaller incision, ligating blood vessels as needed, then cutting through the strap muscles - called the Sofferman technique - to directly access the thyroid. Surgeons use tiny video cameras and endoscopes to work through the incision. Afterward, the strap muscles are repaired and the incision closed with medical-grade glue. Reduced tissue trauma means less chance of postoperative drainage from the site. Patients may go home the same day or spend one night in the hospital compared to two to three days with the older technique. None of the patients selected for the minimally invasive approach had to be converted to conventional thyroidectomy. One of the minimally invasive patients developed a mildly thick scar that responded to treatment.
"It works great," says Dr. Terris. "It's really revolutionized how we manage these patients. The biggest thing is that we are doing this typically on young women. They tend to care the most about what their incision is going to look like." Women are more likely than men to develop nodules and thyroid cancer; 31 of the 44 study patients were women, Dr. Terris says. That reality helped inspire his pursuit of less invasive options. "This approach is evolving but is an appropriate addition to the practice of the modern endocrine surgeon," Dr. Terris and his colleagues write.
