基层实用的颈部内镜微创甲状腺手术

Minimally invasive endoscopic thyroid surgery feasible for primary hospital

目的探讨运用常规的双极电凝开展内镜辅助下颈部小切口甲状腺手术的可行性,以适应基层医院开展这一微创手术。方法以内镜辅助小切口甲状腺切除术（Miccoli手术）为基本框架,选用医用常规双击电凝做基本器械,辅以少数其他器械操作,对40例诊断为甲状腺腺肿、甲状腺腺瘤的患者行此种内镜下手术。术中采用游离甲状腺动静脉主要分支、属支的二、三级分属支进分离、牵移、电凝、切断的方法行甲状腺手术。结果 40例手术均获成功,无一例因术中出血失控需中转手术及无一例术后出血再次手术,2例术后声嘶分别在术后第2、第6个月完全恢复正常。术后随访6~37个月肿瘤无复发。结论应用常规的双极电凝在内镜辅助下行小切口甲状腺手术方法可行安全,止血确切,宜在基层医院普及推广。

Objective To explore the feasibility to perform minimally invasive endoscopic thyroid surgery with conventional bipolar coagulation in order to meet the condition in primary hospital.Methods According to the technique described by Miccoli,minimally invasive endoscopic thyroid surgery was carried out in 40 cases of thyroid adenoma.Conventional bipolar coagulation was the principal equipment during the operation.The main steps of the operation included seperation,coagulation and cutting of the involved branches of thyroid artery and thyroid vein.Results The operations in 40 patients were all successful.None required transfer or reoperation due to blood loss during and after the operation.Postoperative hoarseness occurred in 2 patients and recovered 2 and 6 months postoperation respectively.No tumor recurrence was found during 6-37 months follow up.Conclusion Thyroid surgery with endoscope-guided bipolar coagulation is safe,minimally invasive and feasible in primary hospital.