腔镜甲状腺手术的暴露技巧

The exposure of the endoscopic thyroidectomy

目的：探讨完全腔镜甲状腺手术的暴露技巧及术中烟雾的处理技巧。方法：回顾分析76例完全腔镜甲状腺手术患者的临床资料,总结术中视野暴露技巧及烟雾处理技巧。结果：74例成功完成腔镜手术,成功率97.4%;2例中转开放手术。手术时间1.4-5.1 h,平均（2.5±0.7）h;病理结果示甲状腺乳头状癌12例,2例伴淋巴结转移,1例隐匿性癌,8例甲状腺腺瘤,余者均为结节性甲状腺肿。36例行双侧切除术,25例行单侧切除术,13例行单纯肿物切除术。术后平均住院（1.55±0.6）d,术后引流量平均（45±5）ml/d。结论：术者巧妙应用手术工具、熟练掌握视野暴露及烟雾处理技巧,术中可创造良好的手术视野,节省操作时间。

Objective： To investigate the exposure skill of totally endoscopic thyroidectomy and handling method of intraoperative smog. Methods： A retrospective analysis was made on clinical data of 76 patients who underwent endoscopic thyroidectomy,exposure skill and smog processing techniques during operation were summarized. Results： The laparoscopic thyroidectomy was successfully carried out in 74 cases,the success rate was 97. 4%. 2 cases were converted to open surgery. The operative time ranged from 1. 4 h to5. 1 h,the mean was（ 2. 5 ± 0. 7） h. There were 12 cases of thyroid papillary carcinoma,2 cases with lymph node metastasis,1 case of occult carcinoma,8 cases of thyroid adenoma,the rest were nodular goiter. 36 patients underwent bilateral resection,25 patients received unilateral resection,and simple tumor resection was implemented in 13 patients. The mean postoperative hospital stay was（ 1. 55 ±0. 6） d,the average daily volume of drainage after operation was（ 45 ± 5） ml /d. Conclusions： Ingenious use of surgical operation tool for exposure and dealing with smog may create a nice view of operation and simultaneously save operation time.