腔镜甲状腺手术初步应用体会

The clinical application of laparoscopic thyroidectomy:initial experience

目的：探讨经前胸壁入路行腔镜甲状腺手术的临床价值及手术方法。方法：回顾分析2010年1月至2012年7月为16例甲状腺腺瘤患者经前胸壁入路行腔镜甲状腺手术的临床资料。结果：16例患者均经前胸壁入路成功施行腔镜下腺叶大部或次全切除术。术中快速病理及术后常规病理提示甲状腺腺瘤,其中并囊性变3例。手术时间42~164 min,平均96 min;术中出血量5~20 ml,平均8.6 ml;术后颈部引流2~3 d;引流量16~128 ml,平均22.5 ml;术后住院4~8 d,平均5 d;术后发生皮下气肿1例,3 d后消失;无皮下淤血及积液;颈前区不适感1例,3个月后消失。无术后声音嘶哑及术后饮水呛咳,患者均对美容效果满意。结论：经前胸壁入路腔镜甲状腺手术是较成熟的术式,美容效果较好。熟练规范地应用超声刀,解剖层次清晰是避免副损伤的关键;术前标记路径,尽可能缩小前胸壁皮下游离范围是减少术后并发症的有效方法。

Objective：To evaluate clinical value and surgical skills of endoscopic thyroidectomy via the anterior chest wall approach.Methods：The data of 16 cases underwent endoscopic thyroidectomy via the anterior chest wall approach between Jan.2010 and Jul.2012 were retrospectively analyzed.Results：All patients underwent partial or subtotal thyroidectomy.Routine and fast pathologic examination showed that all cases were thyroid adenoma,3 of which consisted of cystis degeneration.The mean operative time was 96（42-164） min.The mean blood loss was 8.6（5-20） ml.The mean drainage after the operation was 22.5（16-128） ml and the drainage time was 2-3 days.The mean postoperative hospital stay was 5（4-8） days.Subcutaneous emphysema occurred in 1 patient and disappeared 3 days postoperation,without subcutaneous congestion and effusion.Neck discomfort occurred in 1 case and disappeared 3 months postoperation,without hoarseness and bucking.All patients were satisfied with the cosmetic effect.Conclusions：Endoscopic thyroidectomy via the anterior chest wall approach is a muture procedure,whose cosmetic appearance is much better.Mastering application of the ultrasonic scalpel and clear anatomical structure is the key to avoid side injury.Marking path preoperative and freeing subcutaneous range as small as possible is effective to reduce postoperative complications.