胸骨上小切口无注气内镜甲状腺手术的临床体会

Clinical experience of no-insufflation endoscopic thyroidectomy by a small incision upon the sternum

目的总结胸骨上小切口无注气内镜甲状腺手术在美容效果、手术适应证、安全性等方面的临床体会。方法以Miccoli术式为基本框架,采用自行设计的悬吊拉钩及固定横杆建立手术空间,用高频超声刀作为切割和止血工具,对51例结节性甲状腺肿患者和1例甲状腺乳头状癌患者行全内镜下手术治疗。结果全部手术顺利完成,无1例因术中或术后出血而改为开放式操作,除1例恶性病例出现暂时性喉返神经麻痹外,其余均无喉返神经损伤。结论胸骨上小切口无注气内镜甲状腺手术切口小,创伤小,恢复快,具有良好的美容效果和安全性,并发症少,可操作性强,具有广泛的推广前景。

Objective To evaluate the cosmetic effect, application and safety of no-insufllation endoscopic thyroidectomy by a small incision upon the stermum. Methods Based on the miccoli style, with the suspensory iustruments designed by us and high frequency ultracision to incise and stanch, no-insufflation endoscopic thyroidectomy by a small incision upon the sternum was performed in 51 patients of nodular goiter and 1 patient of Papillary thyroid carcinoma. Results All operations were successfully carried out. No incision was widened for hemostasis during or after the operation. The patient of Papillary thyroid carcinoma had temporary paralysis and no other complication happened in the recurrent laryngeal nerves. Conclusion No-insufllation endoscopic thyroidectomy by a small incision upon the sternum has the major advantages of small incision, less injury and quicker recovery, and it also has obvious postoperative cosmetic effect and creditable safety. It is an ideal operation for thyroid patients.