改进的Miccoli术式治疗甲状腺良性疾病(附530例报告)

Application of Miccoli's endoscopic thyroidectomy with technical modifications--a report of 530 cases

目的:系列改进Miccoli术式内镜下甲状腺手术的经验总结。方法:结节性甲状腺肿占位和腺瘤病人共530例。按以高频超声刀为主,其他少数特选器械为辅,双械配合方式进行操作。术中用:①预凝闭加交替式(切、吸、凝、分)法控制腺内分离时的渗血;②顺序式(游离鄄凝闭鄄切断法离断血管止血。并借助自行设计的三维空间微调器固定空间即时调整和暂时空间的随时创建两法对操作区局部实施调节。结果:全部手术均顺利完成。有2例出现可逆性喉返神经损伤,无永久性甲状旁腺功能低下症。结论:上述改进技术可以较好地顺应原术式的框架设计,不仅能有效地克服单一径路窄小空间的限制,而且也使操作大为简化。

Objective To assess the value of Miccoli's endoscopic thyroidectomy with some technical modifications.Methods From April 2002 to October 2004, 530 cases of nodular goiter and/or adenoma were consecutively Miccoli's, endoscopical thyroidectomy. The operation was conducted by using mainly the ultrasonic scalpel(Harmonic Scalpel?誖,Johnson & Johnson,USA), aided by suction-dissector or other supplementary instruments. The procedure was applied by: ① pre-coagulation + alternative cuting,suction,coagulation and dissecting or ②sequencial dissection,coagulation and cutting in dividing branches of major thyroid vessels and in controlling bleeding during dissection of the thyroid gland. To utilize maximally the working space, a specially designed space-modulating device was employed for regulating the suspending angle. Results All the procedures were completed successfully. Temporary hoarseness occurred in 2/530 cases (0.38%), but no case of postoperative tetany was observed. Conclusions Ultrasonic scalpel-based and space-regulating techniques are beneficial additive measures in performing endoscopic thyroidectomy. Application of these innovative techniques helps to render this minimally invasive approach simple and reliable.