改良式胸乳晕径路腔镜甲状腺切除术在良性甲状腺病变中的应用

Application of modified endoscopic thyroidectomy via chest and breast areola approach for benign thyroid disease patients

目的探讨改良式胸乳晕径路腔镜甲状腺切除术治疗良性甲状腺病变的安全性和可行性。方法选择2011年3月至2012年3月在我院普外科接受腔镜甲状腺切除术治疗的女性患者56例,原发病均为良性甲状腺疾病。其中28例施行改良式胸乳晕径路腔镜甲状腺切除术(改良组),利用女性乳房可推移性及腔镜手术器械的长杆状特点,在胸乳晕径路腔镜甲状腺切除术的基础上,进行不游离前胸壁皮下间隙的术式改良;28例患者施行胸乳晕径路腔镜甲状腺切除术(原术式组)。两组患者的平均年龄和病因构成无统计学差异。比较两组患者手术时间、术中出血量、术后疼痛程度、术后住院时间及手术并发症发生情况。结果两组患者手术时间、术中出血量、术后住院时间、术后引流量差异均无统计学意义。与原术式组相比,改良组患者术后疼痛减轻(平均疼痛度视觉模拟评分3.0±1.6vs 4.5±1.8,P=0.042),术后前胸壁皮肤红肿或皮下淤斑、水肿、积液发生率降低(0vs 21.4%,P=0.01),两组患者均未出现喉返神经、甲状旁腺损伤,无术后出血。结论改良后的胸乳晕径路腔镜甲状腺切除术治疗良性甲状腺病变安全可行,能明显减少原术式手术创伤。

Objective To study the safety and feasibility of modified endoscopic thyroidectomy via chest and breast areola approach for benign thyroid disease patients. Methods A total of 56 female benign thyroid disease patients, who received endoscopic thyroidectomy in our hospital from March 2011 to March 2012, were included in this study. And 28 of them underwent modified endoscopic thyroidectomy （modified group）. Taking the advantage of movable female breast and the long rod-shaped endoscopic instrument, the operation was modified based on endoscopic thyroidectomy via chest and breast areola approach, without subcutaneous dissection of the chest wall. Another 28 patients received conventional approach treatment （conventional group）. The two groups were matched in mean age and disease causes. The operation time, blood loss, post- operative pain degree, post-operation hospital stay, and complications were compared between the two groups. Results The operation time, blood loss, post-operation hospital stay, and post-operation drainage volume were not significantly different between the two groups. Compared with patients in the conventional group, patients in modified group suffered significantly less post-operation pain, with mean visual analogue scale scores being 3.0±1.6 vs 4.5±1.8 （P=0. 042）. The modified group also had significantly reduced incidence of skin redness and subcutaneous ecchymosis, edema and chance of effusion on the anterior chest wall （0 vs 21.4%, P= 0. 01）. There were no damages to recurrent laryngeal nerve or parathyroid glands or postoperative hemorrhage in the 56 patients. Conclusion The modified endoscopic thyroidectomy via chest and breast areola approach is a safe and effective method, and it can greatly reduce the trauma of conventional endoscopic thyroideetomy.