新型加长Trocar在经乳晕腔镜甲状腺手术的临床应用体会

The clinical application of new extended Trocar in endoscopic thyroidectomy in areola approach

目的：探讨新型加长Trocar在经乳晕腔镜甲状腺手术中的应用体会及并发症的防治措施。方法：回顾分析2014年2月至2015年4月施行的37例经乳晕入路腔镜甲状腺手术。患者全身麻醉后,于右侧乳晕内外缘分别建立观察孔与操作孔,左侧乳晕上缘建立操作孔。应用新型一次性加长Trocar建立皮下隧道并建立颈前操作空间施术。结果：手术均获成功,手术时间65-180 min,平均（99.7±30.1）min;术中出血量5-40 ml,平均（20.0±10.1）ml。其中结节性甲状腺肿21例,甲状腺腺瘤16例。术后48-72 h拔除引流管。术后早期患者均有颈胸部紧缩感及疼痛。5例出现胸前瘀斑,于术后1周吸收。2例术后短暂声嘶。术后住院3-9 d,平均（5.0±1.6）d。37例术后随访0.5-10个月,彩超检查示近期无复发。结论：应用加长Trocar行经乳晕腔镜甲状腺手术安全、可行,并发症轻,美容效果极佳,患者术后满意度高。新型加长Trocar设计巧妙,但仍需完善。

Objective： To study the clinical application experiences of new lengthened Trocar in endoscopic thyroidectomy in areola approach and to explore the prevention and treatment of complications. Methods： A retrospective analysis was made on the clinical data of 37 patients who underwent endoscopic thyroidectomy through areola approach from Feb. 2014 to Apr. 2015. After general anesthesia,observation port and operation port was established in the right areola inner and lateral margin,respectively,and another operative port was established in the upper border of the left areola. The establishment of a subcutaneous tunnel and operation space in front of neck was made with a new type of disposable extended Trocar. Results： The operations were successful,the operation time was 65-180 min,the average operation time was（ 99. 7 ± 30. 1） min. Intraoperative blood loss was 5-40 ml,the mean was（ 20. 0 ± 10. 1） ml.There were 21 cases of nodular goiter and 16 cases of thyroid adenoma. Drainage tube was removed at 48-72 h postoperatively. In the early stage after operation,all patients felt tight and pain in neck and chest. 5 patients suffered from anterior chest ecchymosis,which was absorbed in 1 week after surgery. 2 cases had hoarseness in a short time. The average hospital stay was（ 5. 0 ± 1. 6） d（ range,3-9 d）. 37 patients were followed up for 0. 5-10 months,and no recurrence was found by color Doppler ultrasound. Conclusions： Application of extended Trocar in endoscopic thyroidectomy through areola is safe and feasible,with minor complications,excellent cosmetic results,high satisfaction. The design of the new extended Trocar is clever and still needs to be improved.