改良胸骨前入路在腔镜甲状腺手术中的应用体会

Utility of anterior chest approach in endoscopic thyroidectomy

目的:探讨腔镜甲状腺切除术中改良手术入路的操作方法。方法:将28例甲状腺手术患者随机分为两组,分别采用改良胸骨前入路与传统胸乳入路。结果:改良组中1例快速病理提示乳头状癌,中转开放手术;传统组中1例于穿刺过程中出血120 ml,中转开放手术;余者均顺利完成腔镜手术。改良入路在入路游离时间、出血量、术后疼痛及并发症方面均具有明显优势。术区皮瓣术后无明显手术痕迹,除1例术后胸前出现瘀斑,余均较满意。结论:改良胸骨前入路优于胸乳入路,术中可减少游离出血及游离中的副损伤,缩短手术时间,减少手术并发症,且不影响美容效果;手术安全有效,值得推广应用。

Objective： The purpose of this study is to investigate the modified operative approach of endoscopic thyroidectomy.Methods： Twenty-eight patients who underwent endoscopic thyroidectomy were randomly classified into two groups： modified anterior chest approach group and traditional anterior chest approach group.Results： One case in modified group was converted to open surgery because its rapid pathologic result was papillary carcinoma.1 case in traditional group was converted to open operation since blood loss during puncture was 120 ml.Other endoscopic operations were successful.Modified approach had obvious advantages in dissection time,bleeding volume,postoperative pain and complication.No obvious operative incision was observed in the field of operation.Most patients were satisfied except one patient suffered from postoperative prethoracic ecchymosis.Conclusions： Modified anterior chest approach is better than breast approach,because this procedure is safe,effective and cosmetiv,it can decrease blood loss and vice injury during separation,operative time and operative complications.Modified anterior chest approach is worthy of promotion.