腔镜乳晕径路甲状腺良性肿瘤手术101例分析

The study of the endoscopic thyroidectomy by breast approach for benign thyroid tumor

目的探讨腔镜乳晕径路甲状腺良性肿瘤切除术的可行性和优点。方法2002年8月至2005年5月采用胸部乳晕入路行腔镜甲状腺良性肿瘤切除术101例。其中甲状腺腺瘤40例,结节性甲状腺肿61例。结果成功完成手术100例。1例因出血而转开放性手术。行双侧甲状腺大部分切除术27例(A组),单侧甲状腺大部分切除术64例(B组),甲状腺肿瘤摘除术10例(C组),A组的手术时间明显比B组和C组长,差异有显著意义(q=2.9058,P<0.05;q=4.0463,P<0.05)。A组术后有33.3%须用止痛药,明显高于B组(9.4%)和C组(10.0%),差异有显著意义(χ2=8.459,P=0.01)。而其他指标比较差异无显著意义。结论乳晕径路甲状腺良性肿瘤切除术是一种安全的方法,可同时处理双侧甲状腺病变,可作为甲状腺良性肿瘤的首选手术方法。

Objective To explore the feasibility and advantage of endoscopic thyroidectomy by breast approach in patients with benign thyroid tumor. Methods Total 101 patients were underwent endoscopic thyroidectomy in First Affiliated Hospital of Guangxi Medical University from August 2002 to May 2005 ,including 40 cases of adenoma and 61 cases of nodular goiter. Results One hundred cases were successfully completed endoscopically. There was one case to convert to conventional thyroidectomy because of bleeding. Twenty-seven patients underwent bilateral near total lobectomy （A group） ,64 patients underwent unilateral near total lobectomy （B group）, and 10 patients underwent adenoma enucleation （ C group）. The operating time was （ 147. 67 ± 46.59） min, （ 117.37 ± 51.84 ） min, （ 80. 83 ± 14. 97 ） min in group A, B and C, respectively. It was significantly longer in group A than that of in group B and group C （ q = 2. 9058, P 〈 0.05 ; q =4. 0463, P 〈 0.05 ）. The analgesic requirements was much more in group A （33.33%）than that in group B （9. 38% ） and group C （ 10% ） （x^2 = 8. 459, P = 0. 01 ）. There were no difference in blood loss, volume of drainage, time of stay and postoperation stay, and the time of taken to return to normal activity in all three groups. Postoperative complications occurred in four cases. There were two case （ superior or recurrent laryngeal nerve paralysis） Occurred group A. One occurred in group B（hypocalcemia） and one occurred in group C （bleeding）. Conclusion The results of this study confirm that endoscopic thyroidectomy is a technically feasible and safe procedure. It can successfully treat bilateral thyroid diseases and is a good select for patients of benign thyroid tumor.