经乳晕气管前入路在腔镜甲状腺手术中的应用

The Application of Anterior Approach through Tracheal Path in Laparoscopic Thyroid Surgery

目的探讨经乳晕气管前入路腔镜甲状腺手术的应用价值。方法 2009年11月～2012年6月,对104例甲状腺疾病采用气管前入路施行腔镜甲状腺切除术,其中甲状腺腺瘤25例,结节性甲状腺肿56例,甲状腺功能亢进23例。经乳晕切口穿刺trocar,常规先切断甲状腺峡部,再切断游离气管前筋膜、外侧韧带、悬韧带,解除甲状腺固定(即甲状腺松动),再切断血管,根据病变决定切除多少甲状腺。结果手术均获成功。手术时间85～195 min,平均107 min。术中出血量5～115 ml,平均25 ml。术后住院时间3～6 d,平均4.5 d。2例术后轻微喉返神经麻痹症状(声嘶),经观察分别于术后3、6个月自行恢复正常,无永久性喉返神经损伤。结论气管前入路腔镜甲状腺切除手术操作容易,手术并发症少,是一种安全、简捷的手术方法。

Objective To explore the application of anterior approach through tracheal path in laparoscopic thyroid surgery. Methods 104 cases of thyroid disease （including 25 cases of thyroid adenoma, 56 cases of nodular goiter, 23 cases of hyperthyroidism） underwent laparoscopic thyroidectomy through tracheal anterior from November 2009 to June 2012. Trocar was put through mammary areola incision. Based on conventional practice, isthmus was cut off, and then free tracheal fascia, lateral ligament, and snspensoria were isolated, then the blood vessels were cut off, and how much to thyroid resection was decided based on the lesion size. Results All operations were performed successfully with an average operation time of 107 rain （85 - 195 rain）. The mean blood loss was 25 ml （5 - 115 ml）. The postoperative hospital stay was 3 to6 days with an average of 4.5 days. 2 cases suffered from mild laryngeal nerve palsy, and recovered 3 or 6 months after the surgery. No permanent nerve damage was observed. Conclusion Laparoscopic thyroid surgery through trachea anterior approach is easy to operate with comparatively less surgical complications.