内镜下甲状腺手术的基础研究

Basic research of endoscopic thyroid surgery

目的探讨内镜下甲状腺手术的安全性和可行性。方法 20头中华小型猪随机分为A、B、C、D、E5组,每组4头。A组采用传统开放甲状腺切除术;B、C、D、E组均采用内镜下甲状腺切除术,二氧化碳充气压力分别为4、6、9和12mmHg。分别于术前、注气后1h、注气后2h和停止注气后30min监测HR、MAP、ICP、CVP、PaCO2和pH值。结果传统组和内镜组均顺利完成手术,未出现严重并发症。内镜组中,二氧化碳充气压力为4和6mmHg时,所有指标值波动不大,各个时间点比较,无论组内还是组间,差异都无显著性(P>0.05);二氧化碳充气压力为9mmHg时,出现高碳酸血症和酸中毒,12mmHg时更为明显(P<0.05);当二氧化碳充气压力为12mmHg时,各项监测指标均显著异常(P<0.05)。结论在一定二氧化碳充气压力情况下内镜甲状腺手术是安全有效的。

【Objective】To evaluate the safety and feasibility of endoscopic thyroid surgery.【Methods】20 mini-swines were randomly divided into A,B,C,D,E 5 groups ,4 in each group. A group used the traditional open thyroidectomy; B,C,D,E groups used endoscopic thyroidectomy with CO2 inflation pressure was respectively 4 mmHg,6 mmHg,9 mmHg and 12 mmHg. Respectively,the swines were evaluated before surgery,1h after gas injec-tion,2 h after gas injection and 30 min after the cessation of gas injection to monitor HR,MAP,ICP,CVP,PaCO2 and pH value. 【Results】Both of traditional group and the endoscopic group were successfully completed surgery without serious complications. Endoscopic group,when CO2 inflation pressure was 4 mmHg and 6 mmHg,all indications were steady,the differences were not significant （P〉0.05） in each time points regardless of ingroup comparison or group comparison; when CO2 inflation pressure was 9 mmHg,hypercarbia and acidosis occurred,it was more obvious （P〈0.05） if the pressure got to 12 mmHg; when CO2 inflation pressure was 12 mmHg,the various monitoring indications were significantly abnormal （P〈0.05）. 【Conclusions】If CO2 inflation pressure is in a certain scale,the endoscopic thyroid surgery is safe and effective.