[现代甲状腺手术:高效安全的甲状腺切除术]。

Chirurgie (Heidelberg, Germany) Pub Date : 2024-10-01 Epub Date: 2024-06-11 DOI:10.1007/s00104-024-02100-2
Constantin Aurel Smaxwil, Andreas Zielke
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引用次数: 0

摘要

在经历了数十年的双侧 "次全 "和后来的 "全 "甲状腺切除术后,现在的切除范围是根据主要的甲状腺疾病来单独决定的。在内分泌外科工作组(CAEK)的研究、文献和质量中心(StuDoQ)登记册中,目前最主要的适应症是怀疑恶性肿瘤,其次是良性无症状结节性甲状腺肿、功能性紊乱和确诊的恶性肿瘤。必须严格确定干预的决定和切除的范围。术中神经监测、血管封闭和甲状旁腺自动荧光等辅助手段提高了甲状腺切除术的安全性,但也增加了手术的复杂性。使用现代血管封堵装置进行甲状腺叶切除术的手术技术是一个复杂的过程,其中定位、进入颈部的途径和修改后的解剖步骤顺序同样重要。如今,神经监测技术的实用性已毋庸置疑,但其他技术的实用性尚不明确。不过,最重要的是,现代甲状腺手术的特点是对自身结果的了解和对随访的明确定位。任何手术辅助设备的选择都应基于这一认识。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Modern thyroid surgery : Efficient and safe thyroidectomy technique].

After decades of bilateral "subtotal" and later "total" thyroidectomy, the extent of resection is now determined individually depending on the dominant thyroid condition. The leading indication by far in the study, documentation and quality center (StuDoQ) register of the Surgical Working Group Endocrinology (CAEK) is currently the suspicion of malignancy, which is followed by benign symptomatic nodular goiter, functional disorders and confirmed malignancy. The decision for an intervention as well as the extent of resection must be rigorously established. Aids for intraoperative nerve monitoring, vessel-sealing and parathyroid autofluorescence increase the safety of thyroid resections but also the complexity. The surgical technique of lobectomy using modern devices for vessel sealing is an intricate process in which the positioning, access to the neck and a modified sequence of dissection steps are equally important. While the usefulness of neuromonitoring is nowadays no longer in doubt, this is not yet so clear for other technologies. Above all, however, modern thyroid surgery is characterized by the knowledge of one's own results and a clear positioning to follow-ups. The selection of any surgical aid should be based on this knowledge.

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