经胸壁入路腔镜甲状腺切除术70例临床分析

The clinical analysis of 70 cases endoscopic thyroidectomy via the breast approach

目的:探讨经胸壁入路腔镜甲状腺切除术的优缺点。方法:2007年2月至2009年12月采用经胸壁三孔入路法行腔镜甲状腺切除术70例。其中甲状腺腺瘤18例,结节性甲状腺肿50例,甲状腺癌2例。结果:69例顺利完成腔镜手术,1例因术中出血中转开放。手术时间62～110min,平均80min,甲状腺肿瘤直径1.5～7.5cm,平均4.1cm。行甲状腺肿瘤切除术10例,单侧甲状腺次全切除术24例,单侧甲状腺腺叶切除术12例,双侧甲状腺部分切除术22例,甲状腺癌根治术2例。术后2～3d拔除引流管,术后住院2～5d,平均4d。2例术后声音嘶哑,均于6个月内恢复,3例术后一过性低钙,自行恢复,2例术后局部积液,经2～3次穿刺抽液后好转。术后随访2～35个月,未发现复发病例。结论:腔镜甲状腺手术安全可行,美容效果佳,其中经胸壁三孔入路法操作简便,是较理想的术式。

Objective：To evaluate the advantages and disadvantages of endoscopic thyroidectomy via the breast approach.Methods：From Feb.2007 to Dec.2009,70 patients were selected and given 3-port endoscopic thyroidectomy by the breast approach.There were 18 cases of thyroid adenoma,50 cases of nodular goiter and 2 cases of thyroid carcinoma.Results：Sixty-nine cases were performed successfully by laparoscopy,1 case was converted to open surgery because of intraoperative hemorrhage.The mean operative time was 80min （range 62-110min）,and the mean diameter of the mass was 4.1cm （range 1.5-7.5cm）.Among these patients,10 cases were given mass resection,24 patients underwent subtotal lobectomy,12 total lobectomy,22 bilateral partial thyroidectomy,and 2 cases of radical resection of thyroid cancer.The drainage tubes were removed at 2-3d postoperatively and the mean postoperative hospital stay was 4d （range 2-5d）.2 cases of hoarseness recovered in 6 months,3 cases of postoperative transient hypocalcemia self-recovered,2 cases of postoperative local hydrops improved after 2-3 times puncture and drainage.All patients were followed up for 2-35 months and no recurrence was found.Conclusions：Endoscopic thyroidectomy is a feasible and safe procedure,whose cosmetic appearance is much better than the traditional surgery.The three-port via breast approach is easy to operate and is an ideal operative method.