免气体锁骨下径路腔镜甲状腺切除术探讨

Video assisted endoscopic thyroidectomy using gasless anterior nect lifted method by infraclavicular way

目的 :探讨经锁骨下径路免气体腔镜甲状腺叶切除术的可行性。方法 :于病灶侧锁骨下作 2 5～ 3 0cm切口 ,沿颈阔肌下平面分离至颈前区 ,用直径 3mm的U形克氏针置入皮瓣下 ,经皮外将U形针 3点缝合悬吊于头部框架上 ,建立无气体手术空间 ,利用超声刀行甲状腺叶切除术。结果 :手术成功 19例 ,1例癌肿中转行根治术 ,平均手术时间 2 5± 0 2 5h。出血量 2 5± 5ml。 2例切口轻度感染均Ⅰ期愈合 ,颈部无疤痕。结论 :经锁骨下径路免气体腔镜甲状腺叶切除术是安全、可行的。

Objective:To evaluate the feasibility of endoscopic thyroidectomy using gasless anterior neck lifted method by infraclavicular way.Methods:A single infraclavicular incision of2.5-3.0cm was made on the ipsilated side.The subplatysmal plane was dissected up to just above the anterior neck.A diameter of3.0mm kirschner wire was bent into a U-shaped wire and inserted into the subplatysmal space.The wire was sutured,lifted up and secured onto a horizon-tal bar to build a gasless space.Using ultrasonic scalpel,the thyroidectomy was preformed.Results:Nineteen cases were successfully operated and one case with thyroid cancer was converted to open surgery.The average time of operations was2.5±0.25h and intraoperative blood loss was25±5ml.Two cases with mild wound infection were cured without scar on neck.Conclusions:This method provides a simple way to lift the anterior neck wall for a safe gasless endoscopic thyroid surgery,and the method is safe and feasible.