经胸前径路无注气内镜下甲状腺手术

Gasless endoscopic thyroid surgery through anterior chest approach

目的为了获得更佳的美容效果,使颈前不遗留小切口,该文探讨了无注气胸前入路内镜下技术的可行性。方法2004年7月～2005年10月26例甲状腺肿物患者行经胸前入路的无注气内镜下甲状腺手术。结果26例患者中行单侧腺叶次全切除术17例,单侧腺叶切除术6例,双侧腺叶次全切除术1例,一侧腺叶及对侧部分切除术1例,峡部切除术加双侧腺叶部分切除术1例。手术时间(105.96±21.07)min,手术出血量(18.46±12.47)mL。术后病理:结节性甲状腺肿20例,滤泡性腺瘤4例,乳头状癌1例,桥本氏甲状腺炎1例。术后无出血、呛咳、手足抽搐、皮下气肿等,无中转手术病例。有1例出现暂时性喉返神经麻痹,术后4个月恢复。术后有轻微感觉减退和感觉异常1例,4个月后恢复。所有患者颈前未遗留手术疤痕,对术后美容效果十分满意。结论经胸前径路无注气内镜下甲状腺手术能减低手术的侵袭性,颈前不遗留手术疤痕,具有满意的美容效果,是一种安全可行的内镜下甲状腺手术,可作为甲状腺手术患者的一种新选择。

[Objective] In order to get more cosmetic effects and no small incision left in anterior neck zone, we developed gasless endoscopic thyroid surgery through anterior chest approach and applied this technique. [Methotis] Form July 2004 to Oct 2005, we had used this new technique for 26 cases of nodule. [Results] Among the 26 cases, 17 cases received unilateral subtotal lobectomy, 6 cases received bilateral subtotal lobectomy, 1 case received unilateral lobectomy, 1 case received unilateral lobectomy and contralateral subtotal lobectomy, and 1 case received resecting isthmus and unilateral partial lobes. The operating time was （105.96±21.07） rain and the blood loss was （21.33±15.29）mL. The postoperative pathologic examination showed that there were 20 cases of nodular goiter, 4 cases of follicular adenoma, 1 case of Hashimotos thyroiditis and 1 case of papillary carcinoma. No complications such as bleeding, irritating cough, tetany and emphysema happened after operation. No case needed to change surgical approach. Only 1 case showed temporary paralysis of recurrent laryngeal nerve and recovered 6 months later. 1 case complained hypoesthesia and paraesthesia and recovered 4 months later. All patients had no surgical scar left on neck and were satisfied with the cosmetic effects. [Conclusion] Gasless endoscopic thyroid surgery hrough ante-rior chest approach, this technique is of the efficiency, feasibility and safety. This technique had more cosmetic effects and no scar left on neck. So it will become a new selection for patients with nodule.