全乳晕径路腔镜甲状腺切除术65例

Experience about endoscopic thyroidectomy via areola of breast approach: a report of 65 cases

目的探讨全乳晕径路腔镜甲状腺切除术的可行性、安全性和美容性。方法对65例甲状腺肿瘤(甲状腺滤泡性腺瘤23例、结节性甲状腺肿41例、甲状腺微小乳头状癌1例)患者采用全乳晕径路腔镜甲状腺切除术。结果本组64例顺利完成腔镜下手术,1例因瘤体出血无法控制中转开放手术。其中单侧甲状腺部分切除术14例、甲状腺次全切除术43例、甲状腺近全切除术2例,双侧甲状腺大部切除术4例,甲状腺癌根治术1例。手术时间90~240 min,平均160 min,术中出血量3~20 m L,平均9 m L。术后无声音嘶哑、低钙抽搐等严重并发症。术后随访1~18个月,均无复发,全部患者对手术美容效果表示满意。结论全乳晕径路腔镜甲状腺切除术可行、安全、美容效果好。

Objective To study the feasibility,safety and cosmetic of endoscopic thyroidectomy via areola of breast approach. Methods Endoscopic thyroidectomy via areola of breast approach was performed in 65 female patients. Of the patients,23 cases presented with thyroid follicular adenoma,41 cases with nodular goiter,and 1 case with minimum papillary carcinoma. Results The operations had been successfully performed on 64 cases expect that one case had been transferred to open surgery due to uncontrolled bleeding of the tumor during operation. Among them,14 cases performed unilateral partial thyroidectomy,43 cases performed unilateral subtotal thyroidectomy,2 cases performed unilateral near total thyroidectomy and 4 cases performed bilateral subtotal thyroidectomy. one had been diagnosed with papilly thyroid microcarcinoma according to the frozen section during the operation and performed with total thyroid lobectomy of the affected side and subtotal lobectomy of the contralateral side under the endoscopic approach. The average operation time was 160 minutes（ range,90 - 240 minutes）,the average intraoperative blood loss was 9 ml（ range,3 - 20 ml）. No serious complications were found after operation such as hoarseness and convulsion. The follow-up of 1 - 18 months,no evidence of recurrence,all patients expressed satisfaction with the results of operation and beauty. Conclusion Endoscopic thyroidectomy via areola of breast approach is a feasible and safe procedure with satisfactory cosmetic results. It is worth popularizing.