经乳晕单孔腔镜甲状腺手术13例报告

Single-site Endoscopic Thyroidectomy via the Areola Approach: Report of 13 Cases

目的探讨经乳晕途径单孔腔镜甲状腺手术的可行性、安全性及优势。方法通过单侧乳晕切口建立皮下操作空间,置入腔镜和一个操作器械,应用颈部缝线悬吊技术显露甲状腺,超声刀切离患侧甲状腺。结果 13例手术均顺利完成,未中转三孔腔镜手术或开放手术,8例行甲状腺次全切除术,5例行甲状腺部分切除术。手术时间145～205 min,平均170 min;术中出血量15～40 ml,平均25 ml;术后创面引流总量80～135 ml,平均115 ml,术后3～4 d拔管;术后24 h疼痛视觉模拟评分为1～5分,平均3.2分。术后病理:7例甲状腺腺瘤,6例结节性甲状腺肿。13例术后3个月随访,无明显胸壁创面疼痛、麻木,无颈胸皮肤发紧不适感,患者对美容效果评分(0分为非常不满意,10分为非常满意)为8～10分,平均9.5分。结论经乳晕单孔腔镜甲状腺手术安全可行,具有切口隐蔽、皮下分离面积小、美容满意度高等特点。

Objective To explore the feasibility, saiety and advantages of trans-areola single-site endoscopic thyroldectomy. Methods Totally 13 patients received single-site endoscopic thyroidectomy in our hospital. Subcutaneous operative space was created through a unilateral areola incision, through which laparoscope and surgical instrument were introduced, and neck suture suspension technique was used to reveal the thyroid gland. With an ultrasonic scalpel corresponding thyroid gland was separated and removed. Results The procedure was successfully completed in all the patients without conversion to three-port endoscopy or open surgery. Among the patients, subtotal thyroidectomy was carried out in 8 patients, and partial thyroidectomy was performed on the other 5. The operation time ranged from 145 to 205 min with a mean of 170 min. The intraoperative blood loss was 25 ml （ ranged from 15 to 40 ml）, and total incisional drainage volume was 115 ml in average （80 -135 ml）. The drainage tube was removed in 3 to 4 days postoperation. 24-hour postoperative VAS ranged from 1 to 5 （ mean, 3.2）. Postoperative pathological examination showed thyroid adenoma in 7 patients and nodular goiter in the other 6. The patients were followed up for 3 months, during which no one complained of incisional pain, palsy or skin tightness. The mean cosmetic satisfaction score was 9.5, ranging from 8 to 10 （0 = least unsatisfied, 10 = most satisfied）. Conclusion Single-site endoscopic thyroidectomy is safe and feasible with advantages in cosmetic outcomes and less dissection area.