Endoscopic subtotal thyroidectomy in treatment of nodular goiter: a report of 72 cases / 中华内分泌外科杂志

ABSTRACT

Objective To explore effects of endoscopic subtotal thyroidectomy on nodular goiter and its clinical significance.Methods From Jun.2004 to Dec.2009,72 patients with nodular goiter underwent endoscopic subtotal thyroidectomy in Southwest Hospital.Of the 72 cases,22 cases had left-side nodule,31 cases had right-side nodule and 19 cases had bilateral nodules.Single thyroid nodule occurred in 41 cases and multiple nodules in 31 cases.The total number of nodules was 113.The average nodule size was 2.8 cm(ranging from 0.4 to 6.3 cm).Results Of the 72 cases,19 patients underwent bilateral subtotal thyroidectomy and the mean operative time was 97 min(ranging from 80 to 150 min).53 patients underwent unilateral subtotal thyroidectomy and the mean operative time was 65 min(ranging from 25 to 120 min).The mean intraoperative blood loss was 45 ml (ranging from 5 to 120 ml).Of the 72 cases,68 cases were given cervical plexus block regional anesthesia and among them 66 cases(97%)acquired good anesthesia.Temporary hoarse voice occurred in 2 cases and postoperative bleeding occurred in the subcutaneous tunnel of breast in 2 cases.Patients were followed up from 3 to 5years and the cosmetic result was satisfactory.The postoperative review half year later showed that unilateral nodule recurred in 1 case and the recurrence rate was 1.4%.Conclusions Endoscopic subtotal thyroidectomy through anterior chest wall or breast approach under local anesthesia is a safe and effective treatment in nodular goiter.In the process of dissecting thyroid,blunt maneuver and proper use of ultrasonic knife instead of clamping thyroid nodules directly are recommended in order to reduce intraoperative blood loss and enhance safe practice.