经胸乳径路腔镜甲状腺手术180例的临床研究

The experience of endoscopic thyroidectomy by trans-thoracoareolar approach with 180 cases

目的探讨经胸乳径路腔镜甲状腺手术技巧及其并发症的防治。方法回顾分析2005年3月至2009年12月经胸乳径路腔镜甲状腺手术180例患者的临床资料。结果本组178例腔镜甲状腺手术顺利完成,2例中转开放手术,其中1例为结节性甲状腺肿,因甲状腺体积大,空间狭小中转开放手术,另1例为原发性甲状腺功能亢进,因粘连严重、创面广泛渗血中转开放手术。全组手术时间70～190 min,平均110 min。术中出血量5～75 ml。术后出现皮肤瘀斑2例,抽搐1例,均于2周后恢复正常。声音嘶哑1例,1个月后恢复正常。住院时间3～6 d,平均4.5 d。结论经胸乳径路腔镜甲状腺手术是一种极富技巧性的手术,甲状旁腺损伤和喉返神经损伤是其严重并发症,规范手术操作能有效减少并发症的发生。

Objective To explore the skills and precenting complications of endoscopic thyroidectomy by trans-thoracoareolar approach.Methods The clinical data of 180 cases of endoscopic thyroidectomy by trans-thoracoareolar approach from March 2005 to December 2009 were analyzed retrospectively.Results The operation in 178 cases were successed.Two cases were converted to open operation.One case converted to open operation was nodular goiter,because of large thyroid gland and small operation space;the other case was hyperthyroidism,because of severe adhesion and extensive intraoperative bleeding.The operative time was from 70 min to 190 min,the average 110min.Intraoperative blood loss was from 5 ml to 75 ml.There were 2 cases of postoperative skin ecchymosis and 1 case of postoperative seizures who got well in 2 weeks.There was 1 case of hoarseness who got well in a month.Length of stay was from 3 days to 6 days,the average was 4.5 days.Conclusions Endoscopic thyroidectomy by trans-thoracoareolar approach has skill nature.Recurrent laryngeal nerve injury and parathyroid injury are serious complications.Standard operation can effectively reduce the complication incidence.