改良法经乳晕入路内镜下甲状腺切除术

Total endoscopic thyroidectomy by the breast approach and partial improvement

目的探讨改良法经乳晕入路内镜下甲状腺切除术的临床价值。方法应用经乳晕入路内镜下甲状腺切除术治疗甲状腺疾病32例,并对该手术予部分改进:将中间的切口选在两乳头连线中点下方约1.0～1.5cm处;缝合颈前肌群时让患者去枕头,平卧位,使颈前肌群充分松弛;在甲状腺创面置引流管一条,术后2、3d拔除;术后第9天拆线。结果30例手术顺利完成。2例中转开放手术,其中1例因在处理上极时出血不能控制;1例因术中快速病理检查为甲状腺滤泡状肿瘤需行双侧甲状腺全切。1例因结节较大且位于甲状腺下极后内方,术后出现声音嘶哑,1个月恢复正常。出血量约50～80mL,手术时间为100～240min。结论手术的部分改进更能满足年轻女性患者的美容要求,使手术操作更容易。把握中转开放手术时机可减少手术后并发症的发生。

[Objective] To summarize the experience of total endoscopic thyroidectomy （TET） by the breast approach, and explore the value of partial improvement. [Methods] 32 patients suffering from thyroid diseases were treated with TET by the breast approach. This operation was partially improved： the middle incision was selected at 1-1.5 centimeter under the midpoint of breast linkline; when frontneck muscles were sewed. The pillow behind the patient＇s head was removed to relax frontneck muscles; a drainage tube was inserted into the wound surface of thyroid, and drawn within 2-3 days after operation; stitches were taken out at the 9th day after surgery. [Results] TET was successfully finished for 30 patients. Only 2 patients were reserved to open surgery because of the uncontrolled hemorrhage and the thyroid carcinoma. Hoarseness occurred for 1 patient within one month after operation. Bleeding quantity was 50-80 milliliters. Operative time was 100-240 minutes. [Conclusion] B ultrasonic examination and nodal orientation for thyroid before surgery has the important significance to select the indication of TET and estimate the difficulty of the operation. The operative partial improvement may further satisfy the beautiful demand of the young female patients and mitigate the difficulty of the operation. The command of the time for transforming to open surgery may decrease the occurrence of the post-operative complications.