学习曲线内胸乳入路腔镜甲状腺切除术的难点探讨

Discussion on the difficulties of endoscopic thyroidectomy via chest and breasts approach in learning curve

目的:分析探讨学习曲线内行胸乳入路腔镜甲状腺切除术的手术难点。方法:回顾分析为31例患者行经胸乳入路腔镜甲状腺切除术的临床资料,分析术中遇到的难点。结果:29例顺利完成腔镜手术,2例因术中冰冻病理检查示甲状腺癌而中转开放;1例术后皮肤瘀斑形成;3例因术中皮下空间层次过浅需调整层次;7例术后胸前区疼痛较重;1例术中钳夹甲状腺组织破碎而止血困难;3例术中寻找甲状腺肿瘤困难;术后1例声音嘶哑。结论:在学习曲线内行胸乳入路腔镜甲状腺切除术选择合适的病例,强调术中精细操作,可避免学习曲线内发生严重的手术并发症。

Objective：To analyze and discuss the difficulties of endoscopic thyroidectomy via chest and breasts approach in learning curve.Methods：The operative difficulties of 31 cases underwent endoscopic thyroidectomy via chest and breasts approach were retrospectively analyzed.Results：Among the 31 patients,2 were transferred to open operation for thyroid carcinoma prompted by rapid pathological examination,one got skin ecchymosis,three operative planes needed to be adjusted for too superficial subcutaneous space,7 suffered from pain in the front chest,one was difficult in stopping bleeding for thyroid tissue disintegration caused by using pliers in operation,three cases of thyroid tumors were difficult to be found,and one patient got hoarseness.Conclusions：The proper patients should be selected for endoscopic thyroidectomy via chest and breasts approach in learning curve and precise procedure can avoid serious complications in learning curve.