经乳晕径路腔镜甲状腺手术17例

Study of endoscopic thyroidectomy through breast areola approach on 17 cases

目的：探讨经乳晕径路腔镜甲状腺手术的可行性及临床价值。方法：2004年3月至2006年3月,施行乳晕径路腔镜甲状腺切除术17例,其中单纯腺瘤切除8例,部分腺体切除9例。结果：手术全部成功,手术时间75-180m in,平均手术时间109m in。术中出血10-100m l,平均出血量33.5m l,术后48-72h拔除引流管,术后均有颈胸部紧缩感及疼痛,5例出现胸前淤斑,其中4例为乳房前淤斑,术后1周吸收。2例短时间内轻度声音嘶哑,2例乳沟切口局部感染,术后住院3-7d。12例术后随访2-12个月,彩超检查近期无复发。结论：经乳晕径路腔镜甲状腺手术安全可行,美容效果极佳。丧失触觉的腔镜甲状腺手术具有一定的盲目性,存在着漏诊、漏切的隐患。

Objective To explore the feasibility and clinical advantage of endoscopic thyroidectomy through the breast areola approach. Method From March 2004 to March 2006, 17 patients underwent endoscopic thyroidectomy, including 8 cases of adenoma enucleation and 9 cases of part lobcctomy. Results 17 cases all successfully completed the endoscopic thyroidectomy. The operative time was 75 - 180 min and the mean time was 109 min. Intraoperative blood loss was 10 - 100 ml and the mean blood loss was 33.5 ml. Drainage tube was removed 48 - 72 hours postoperatively. All the patients had cervical complication. 5 cases had skin silt patch in the anterior chest and 4 cases of them had skin silt patch in the breast, which was absorpted 1 week after surgery. 2 cases had hoarseness for short time and 2 cases had wound infection between bilateral nipples. Hospital stay after operation was 3 - 7 days. 12 cases were followed up for 2 - 12 months, and no recurrence evidence was identified by colour Doppler ultrasound. Conclusion Endoscopic thyroidectomy through breast areola approach is safe and applicable, also with good cosmetic effects. Endoscopic thyroidectomy with sense of touch disappearing is blindness and may lead to missed - diagnosis.