局部麻醉下免注气锁骨下途径腔镜辅助甲状腺肿瘤切除术65例

Video assisted endoscopic thyroidectomy under local anaesthesis using gasless method by infraclavicular way report of 65 cases

目的探讨局部麻醉下免注气锁骨下途径腔镜甲状腺肿瘤切除术在甲状腺外科应用的的优缺点及其可行性。方法局部麻醉下患侧锁骨下方做2～4cm切口，沿颈阔肌下平面分离至颈前区，使用皮肤拉钩及缝线牵拉方法建立无气体空间，利用超声刀分离行甲状腺肿瘤切除术，2例行甲状腺癌根治术。结果65例均手术成功，平均手术时间60±10min。出血量25±12．5ml。4例皮瓣下积液，1例切口感染，引流、换药后均治愈，1例出现声音嘶哑，营养神经治疗2周后痊愈。随访1～59个月，肿瘤无复发。结论免注气锁骨下途径腔镜甲状腺瘤切除术具有操作简单、完全、美观效果；如尽量减少术后切口并发症的发生，切实可推行该手术方式。

objective ： To evaluate the feasibility and benefit of endoscopic thyroidectomy using gasless method by infraclavicular way o Methods ： A single infraclavicular incision of 2-4cm was made on the ipsilated side under local anaesthesia, The subplastys mal plane was dissected up to just above the anterior neck. building a gasless space by mechanical method.Using ultrasonic scapel, the thyroidectomy was performed, and two patients underwent radical thyroidectomy o Reseults ： all cases were successfully operated o The average time of operations was 60±30min and intraoperative blood loss was 25±12.5ml.Four cases with endermic fluidify and one case suffered from wound infection were cured by draining o Follow-up 1 ~ 59Months, without tumor recurrence. Conclusions： this method provides a simple safe way to perform thyroidectomy using gasless method, having no scar on the neck. if the complication of wound could be controlled satisfactorily, this method would be safe and feasible.