CO2气体灌注内镜甲状腺手术的研究

Endoscopic thyroidectomy with carbon dioxide （CO2） insufflation and clinical observation

目的 观察内镜甲状腺手术CO2充气对机体病理生理的影响,探讨CO2充气内镜甲状腺手术临床应用的可行性.方法 通过动物颈部灌注CO2气体压力及其内镜甲状腺切除术实验,检测动物在术前、术中30、60 min和手术结束各时段心率（HR）、呼吸频率（BR）、PH、PaO2、PaCO2和BE.依据CO2气体灌注内镜甲状腺手术的基础,分析经前胸壁入路内镜甲状腺切除术31例临床资料.结果 应用6mmHg CO2（1 mmHg=0.133 kPa）充气压力建立操作空间,实验动物的BR、HR、PH、PaO2、PaCO2和BE在手术过程中无明显变化.应用12 mmHg CO2充气压力建立操作空间,实验动物的BR、HR、PH、PaO2、PaCO2和BE变化差异均有统计学意义（P〈0.01）.临床31例患者均顺利完成手术,其中行甲状腺部分切除加例,甲状腺次全切11例.平均手术时间113 min,平均术中出血量6 ml,术后平均引流时间2.83 d,术后平均住院时间4 d.术后无喉上、喉返神经损伤及甲状旁腺损伤,无高碳酸血症出现.所有病例随访1～10个月均无不适.结论 严格掌握手术适应证及禁忌证,掌握其并发症的特点和防治措施,完善相应的围手术期处置,临床上将CO2气体灌注压力控制在4～6 mmHg,进行内镜甲状腺切除术安全可行,具有良好的微创、美观效果.

Objective Endoscopic thyroidectomy was performed in pigs with carbon dioxide （CO2） insufflation in the neck. The effects of different levels of insufflation pressure and organism physiological functions changes were collected in order to discuss the feasibility and safety of clinical application of endoscopic thyroidectomy. Methods According to the insufflation pressure in the neck. and receiving CO2 insufflation underwent endoscopic thyroidectomy in the animals. Heart rate （HR） , breathing rate （BR）,PH, arterial partial pressure of O2 （PaO2）, arterial partial pressure of CO2 （PaCO2） and base excess （BE） were measured at preoperative,30 min,60 min after CO2 insufflation,and end of the operation. According to the animals experiment rationale, the clinical data of 31 patients underwent endoscopic thyroidectomy through the anterior chest approach were analyzed retrospectively. Results Insufflation of 6 mmHg CO2 did not have any significant effect on BR,HR,PH,PaO2 ,PaCO2 and BE at any time spot. Insufflation of 12 mmHg CO2 significant increase on BR,HR,PH,PaO2 ,PaCO2 and BE at any time spot （P〈0. 01）. 31 cases were completed successfully,20 cases were partial resection and 11 cases were sub-total resection. The mean operative time was 113 minutes,mean blood loss was 6 ml,mean post-operative drainage time was 2. 83 days, mean length of post-operative hospital stay was 4 days. No superior laryngeal nerve and recurrent laryngeal nerve injury, no parathyroid injury and no hypercapnia. All patients were followed-up from one to ten month,no complaints. Conclusion With strict control at indication and contraindication,manage the complication and prevention and complete the perioperation treatment,endoscopic thyroidectomy is feasible and safe and superiority at its minimally invasive procedure and cosmetology effect. Insufflation pressure at 4-6 mmHg is recommended for clinical application.