Đánh giá kết quả sớm điều trị ung thư tuyến giáp thể biệt hóa bằng phẫu thuật nội soi cắt tuyến giáp qua ngả nách - quầng vú tại Bệnh viện Bình Dân

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Anh Duy Lê, Văn Việt Thành Nguyễn

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y Dược học Phạm Ngọc Thạch, 2024

Mô tả vật lý: tr.168

Bộ sưu tập: Báo, Tạp chí

ID: 442261

Thêm vào giỏ Liên kết toàn văn

Đặt vấn đề: Phẫu thuật nội soi (PTNS) đang ngày càng được phát triển, dần khẳng định được vị trí quan trọng trong điều trị ung thư tuyến giáp. Hiện nay, tại Việt Nam, các công trình nghiên cứu về PTNS cắt tuyến giáp qua ngả nách - quầng vú để điều trị bệnh lý ung thư tuyến giáp còn khá khiêm tốn. Mục tiêu nghiên cứu: Đánh giá kết quả sớm của PTNS cắt tuyến giáp qua ngả nách - quầng vú trong điều trị bệnh lý ung thư tuyến giáp thể biệt hóa. Phương pháp nghiên cứu: Hồi cứu mô tả hàng loạt trường hợp. Chúng tôi phân tích 25 trường hợp UTTG được PTNS cắt tuyến giáp qua ngả nách - quầng vú từ tháng 01/2016 đến tháng 6/2022 tại khoa Ngoại Lồng ngực - Bướu cổ bệnh viện Bình Dân. Kết quả: 25 trường hợp được PTNS cắt tuyến giáp qua ngả nách - quầng vú, không có trường hợp nào chuyển mổ mở. Tuổi trung bình là 40,2. Kích thước u trung bình 1,48 ± 0,79cm. 100% trường hợp làm FNA trước mổ. Có 10 trường hợp (40%) u ở thùy phải , 6 trường hợp (24%) u ở thùy trái và 9 trường hợp (36%) u ở cả 2 thùy. Chúng tôi cắt toàn bộ tuyến giáp cho 10 trường hợp (40%), cắt thùy giáp + eo giáp 4 trường hợp (16%) và cắt 1 thùy tuyến giáp 9 trường hợp (44%). Có 1 trường hợp nạo hạch cổ nhóm VI. Thời gian mổ trung bình 110 ± 9 phút. Máu mất trung bình 19 ± 3 ml. Nằm viện sau mổ trung bình 3,4 ± 1,3 ngày. Có 3 BN (12%) khàn tiếng tạm thời sau mổ với thời gian phục hồi khoảng 4-6 tuần. 2 trường hợp BN (8%) hạ calci máu tạm thời sau mổ. Các biến chứng khác như dò dưỡng trấp, tụ dịch hay nhiễm trùng vết mổ chưa ghi nhận có trường hợp nào. Sau mổ BN ít đau, hài lòng về mặt thẩm mỹ, cơ năng và vận động của BN trở lại bình thường nhanh. Chưa ghi nhận trường hợp nào tái phát hay di căn. Kết luận: Điều trị UTTG thể biệt hóa giai đoạn sớm bằng PTNS cắt tuyến giáp qua ngả nách - quầng vú có thể thực hiện an toàn và thuận lợi, mang lại kết quả sớm tốt. Cần nghiên cứu tiếp tục về hiệu quả điều trị lâu dài về mặt ung thư học.Abstract Background: Endoscopic techniques have recently been applied to thyroid surgery and affirming its important role in surgical treatment of thyroid cancer. Currently in Vietnam, research projects on endoscopic thyroidectomy via axillo - bilateral - breast - approach in treating thyroid cancer are still quite modest. Purpose: To evaluate the operative feasibility and safety of endoscopic thyroidectomy via axillo - bilateral - breast - approach for the treatment of the patients with differentiated thyroid carcinoma. Method: Retrospective description of case series. We analyzed 25 patients who underwent endoscopic thyroidectomy via axillo - bilateral - breast - approach for differentiated thyroid cancers between January 2016 and June 2022 at Binh Dan Hospital. Results: All patients were successfully performed with endoscopic procedure. There was no case conversed to open surgery. The mean age was 40,2. The mean diameter of tumors was 1,48 ± 0,79cm. 100% cases underwent FNA before surgery. There were 10 cases (40%) from right lobe, 6 cases (24%) from left lobe and 9 cases (36%) from both lobes. Endoscopic procedures were 10 total thyroidectomies (40%), 9 lobectomies (36%) and 4 lobectomy plus isthmusectomy (16%). One patient was performed central lymph node dissection. The mean operating time was 110 ± 9 minutes. the mean bleeding volume was 19 ± 3 ml. The mean length of the hospital stay was 3,4 ± 1,3 days. There were 3 cases (12%) of hoarseness due to recurrent laryngeal nerve injury but recovered after 4-6 weeks. 2 cases (8%) had temporary hypoparathyroidism. No further complications such as chylous fistula, seroma or surgical site infection. All patients felt less pain and satisfied with the cosmetic outcomes. All patients are not recurrence or metastasis during follow-up. Conclusion: Endoscopic thyroid surgery via axillo - bilateral - breast - approach is a feasible and safe method for the treatment of early differentiated thyroid cancer. This technique had better cosmetic results and the long-term effect of this technique needs further evaluation. DOI: 10.59715/pntjmp.3.1.19

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