经腋窝入路腔镜甲状腺切除术的临床研究

The clinical research of endoscopic thyroidectomy by axillary approach

目的：探讨经腋窝入路腔镜甲状腺切除术的临床效果。方法：收集2011年10月至2013年10月为25例患者行腔镜经腋窝单侧甲状腺切除术的临床资料,其中男3例,女22例,术中及术后病理检查结果为甲状腺腺瘤3例,结节性甲状腺肿22例。结果：24例在完全腔镜下完成手术,中转开放手术1例,手术时间80～170 min,平均（130.0±19.7）min。术后住院2～4 d,平均（2.5±0.4）d,引流管留置时间1～3 d,平均（1.8±0.3）d,术区引流量50～200 ml,平均（120.0±30.9）ml,无喉返神经及甲状旁腺损伤、切口感染等并发症发生,无术后出血需再次手术患者。术后随访3个月,颈部术区皮下积液1例,其余患者无明显并发症发生,患者对手术的美容效果满意。结论：经腋窝入路腔镜甲状腺切除术安全、可行,手术效果与传统手术相同,因瘢痕位于腋窝美容效果更佳。

Objective ： To evaluate the clinical effect of endoscopic thyroidectomy by the axillary approach. Methods ： The clini- cal data of 25 patients who underwent endoscopic unilateral thyroidectomy from Oct. 2011 to Oct. 2013 were collected. There were 3 males and 22 females. Intraoperative and postoperative pathological examination results were 3 cases of thyroid adenoma, 22 cases of nodular goiter. Results ： Totally endoscopic operation was completed in 24 cases, 1 case was converted to open operation. Operation time was 80-170 min,with the average of （ 130.0 ± 19.7） rain. Postoperative hospital stay ranged from 2 to 4 d,the mean was （2.5 ± 0.4） d. Drainage tube was removed （ 1.8± 0.3 ） d （ range, 1-3 d） later. The drainage volume of operation area ranged from 50 to 200 ml, with the average of （120.0 -＋ 30.9 ） nd. No complications were found such as incision infection, laryngeal recurrent nerve or parathyroid in. No patients were re-operated for postoperative hemorrhage. Patients were followed up for 3 months after operation, 1 patient suffered from subcutaneous effusion at the neck area, no other obvious complications occurred. Patients were satisfied with the cosmetic results of operation. Conclusions ： The endoscopic thyroidectomy by axillary approach is safe and feasible ,its operative effect is the same with traditional operation, the cosmetic result is better because the scar is hidden in axillary fossa.