Objective: To investigate the feasibility and safety of endoscopic surgery for the treatment of primary hyperthyroidism with goiter. Methods: A total of 140 patients with primary hyperthyroidism and different degrees of thyroid enlargements were included who underwent endoscopic surgeries via a trans breast approach in the Second Affiliated Hospital of Zhejiang University School of Medicine from 2013 to 2023, including 137 females and 3 males, aged from 16 to 49 years old. Thirty-one cases had normal thyroid size, 25 cases had Grade Ⅰ enlargement, 56 cases had Grade Ⅱ enlargement, and 28 cases had Grade Ⅲ enlargement. Demographic characteristics, operative time, intraoperative blood loss, and postoperative complications were described, analyzed, and compared among groups. Student's t-test, Mann-Whitney U test, chi-square test, Fisher exact test or one-way analysis of variance (ANOVA) were used for statistical analyses. Results: The patients with Grade Ⅲ enlargement were younger compared to other groups (F=5.58, P<0.01), and also had significantly longer operative time (F=2.81, P=0.04). The probability of conversion to open surgery in the Grade Ⅲ enlargement group was 10.7% (3/28), significantly higher than other groups (0/31, 0/25, 1/56, χ2=8.11, P=0.04). There were no significant differences among the four groups in terms of other demographic indicators and the incidences of postoperative complications (including recurrent laryngeal nerve injury, hypocalcemia, and surgical site infection). There was no significant difference in the probability of temporary hypoparathyroidism among the 4 groups. One patient with permanent hypoparathyroidism appeared respectively in the normal size group and Grade Ⅱ enlargement group. The average follow-up time was 4.2±3.7 years and 14 cases were lost to follow-up, and the patients had high satisfaction with"no neck scar"but with mild chest discomfort. Conclusion: The risk of endoscopic thyroid surgery in the treatment of primary hyperthyroidism with goiter is controllable, and patients with hyperthyroidism combined with Grade Ⅲ enlargement should be especially vigilant against the risk of conversion to open surgery.
目的： 探究腔镜手术治疗原发性甲状腺功能亢进症（甲亢）合并甲状腺肿大的可行性与安全性。 方法： 回顾性纳入浙江大学医学院附属第二医院2013—2023年收治的140例甲亢伴甲状腺不同程度肿大行胸前入路腔镜手术治疗的患者资料，女性137例，男性3例，年龄16~49岁。甲状腺正常大小31例，Ⅰ度肿大25例，Ⅱ度肿大56例，Ⅲ度肿大28例。分析比较各组人口统计学特征、手术时间、术中出血量及术后并发症等因素。根据数据变量性质采用相应的Student′s t检验、Mann-Whitney U检验、卡方检验、Fisher精确检验或单因素方差分析（ANOVA）等统计方法。 结果： Ⅲ度肿大患者年龄较其他组更小（F=5.58，P<0.01），手术时间较其他组更长（F=2.81，P=0.04），Ⅲ度肿大组中转开放概率达10.7%（3/28），显著高于其他组（0/31、0/25和1/56，χ2=8.11，P=0.04）；差异均有统计学意义。4组患者在其他人口统计学指标、术后并发症（包括喉返神经损伤、低钙血症、术区感染）发生率比较中差异无统计学意义（P值均>0.05）。甲状腺正常大小和Ⅱ度肿大组中各出现1例永久性甲状旁腺功能减低患者，但4组间发生暂时性和永久性甲状旁腺功能减低的发生率比较差异均无统计学意义（P值均>0.05）。随访（4.2±3.7）年，失访14例，患者胸部不适感较轻，对“颈部无瘢痕”具有较高的满意度。 结论： 腔镜手术治疗原发性甲亢合并甲状腺肿大可行，风险可控，其中甲亢合并Ⅲ度肿大患者需特别警惕中转开放的风险。.