经乳晕入路完全腔镜甲状腺手术的操作技巧与体会

Operating skill and experience on complete endoscopic thyroidectomy through areola

目的:探讨经乳晕入路腔镜下甲状腺切除术的操作技巧。方法:收集2016年1月~12月符合条件的268例甲状腺疾病患者的临床资料,其中59例经乳晕入路行完全腔镜甲状腺切除术(腔镜组),209例行传统开放甲状腺手术(开放组)。比较两组手术时间、出血量及面部皮下气肿、声音嘶哑、窒息、Horner综合征、饮水呛咳、纵隔气肿、Trocar隧道感染及术区感染等术后并发症。结果:两组手术时间差异无统计学意义[(76.58±29.12)min vs.(73.21±28.14)min];腔镜组出血量少于开放组[(20.71±14.32)ml vs.(33.28±12.19)ml],差异有统计学意义;术后并发症(饮水呛咳、皮下气肿、引流管口红肿、声音嘶哑、口周及手足麻木等)发生率两组差异无统计学意义。术后7 d切口美容效果评分腔镜组优于开放组。结论:注射适量空气减少烟雾产生,熟练的超声刀及分离钳配合操作是乳晕入路腔镜下甲状腺手术成功的关键。经乳晕入路完全腔镜下甲状腺手术可作为甲状腺良性肿瘤的优选方案。

Objective：To discuss the operating skill of endoscopic thyroidectomy through areola. Methods：Fifty-nine patients underwent endoscopic thyroidectomy through areola （ endoscopic group） and 209 patients underwent open thyroid surgery （ open group） from Jan. 2016 to Dec. 2016 in the first affiliated hospital of Xinxiang medical university. The operation time, blood loss, incidence of postoperative complications such as face subcutaneous emphysema, hoarseness, suffocation, Horner syndrome, drinking choke, mediastiual emphysema,Trocar tunnel infection and infection of surgery area were compared between the two groups. Results：There was no statistical difference in operation time between two groups [ （76.58 ± 29.12） min vs. （73.21 ±28.14） min]. Blood loss of endoscopic group was statistically less than open group [ （20.71 ± 14.32） ml vs. （33.28 ±12.19） ml]. There was no obvious difference in incidence of postoperative complications, including drinking choke, subcutaneous emphysema, red and swollen drainage entrance, hoarseness,peri-oral and extremity numbness. In 7 d after surgery, endoscopic group was better than open group in cosmetic results. Conclusions ： Injecting appropriate air to decrease smog and compounding practice of ultrasound knife and dissecting forceps are the key to success in endoscopic thyroidectomy through areola. Complete endoscopic tbyroidectomy through areola could be regarded as better scheme for thyroid benign tumor.