130例胸、乳径路腔镜甲状腺手术临床体会

Clinical experiences of 130 cases of endoscopic thyroidectomy via thoracic and mammary approach

目的探讨腔镜甲状腺手术的应用技术、技巧。方法回顾性分析2007年5月~2009年8月在我科进行的经乳晕、前胸壁径路腔镜下甲状腺手术130例患者的临床资料,术中对实性或混合性肿块采用了经皮或术腔内缝线悬吊甲状腺肿物后60例,未采用40例;囊性肿物采用经皮或囊内穿刺抽液20例,未采用10例;采用对切口美容缝合、皮下注射地塞米松、切口放疗的方法50例,未采用80例。结果使用缝线悬吊牵拉甲状腺肿物者比未使用者手术时间平均缩短了15.5 min,囊性肿物使用经皮或囊内穿刺抽液的方法手术时间平均缩短了18.5 min,采用术中皮下切口美容缝合、皮下注射地塞米松、切口放疗的方法较未使用者大大缩小或消除了手术瘢痕,提高了美容效果。结论腔镜甲状腺手术术中采用经皮或术腔内缝线悬吊甲状腺肿物,囊性肿物经皮或囊内穿刺抽液的方法使手术简易化,缩短了手术时间,扩大囊性肿物手术适应证。采用皮下美容缝合、皮下注射激素、术后切口放疗的方法可提高美容效果。

Objective To discuss the application techniques and skills of endoscopic thyroidectomy.Methods Retrospectively analyzed the clinical data of 130 cases of endoscopic thyroidectomy via thoracic and mammary approach from May 2007 to August 2009.60 cases were used suture to draw the tumor through skin or intracavity,40 cases didn′t use.20 cases used aspirating the fluid through skin or the bladder of the cyst for the cystic cases,10 cases werenot use.50 cases were used cosmeticly suturing the incision,injecting dexamethasone subcutaneously and irradiating the incision,80 cases were not use.Results Suture using to draw the tumor had cut down 15.5 min of operation time averagely.Aspirate the fluid through skin or the bladder of the cyst had cut down 18.5 min of operation time averagely.Cosmeticly suture the incision,inject dexamethasone subcutaneously and irradiate the incision had profoundly deduced or elimininated the scar and inhanced cosmetic effects.Conclusion The use of suture to draw the tumor and subcutaneous injections the fluid through skin or the bladder of the cyst simplified the operation can deduce operation time,enlarge the indications of cystic tumors.Meanwhile,cosmeticly suturing the incision,injecting dexamethasone subcutaneously and irradiating the incision can profoundly reduce or eliminate the scar and enhance the cosmetic effects.