完全腔镜甲状腺手术的少见并发症及其预防策略

Unusual complications of totally endoscopic thyroidectomy and its prevention strategies

完全腔镜甲状腺手术经过22年的不断发展革新,证明了它的安全性和可行性,并且其微创及美容的优势是毋庸置疑的。但是,由于完全腔镜甲状腺手术操作空间狭小,甲状腺血运丰富,毗邻喉返神经、喉上神经、甲状旁腺、气管、食管、淋巴管等重要组织结构,若操作技术不熟练,容易出现一系列严重的相关并发症。尤其是一些临床中发生率低、教科书未具体讲述和国内外文献少有报道的少见的并发症,例如:迟发性出血、迟发性声嘶、乳糜漏、食管及气管损伤、气胸、CO2栓塞等,通常会被忽视而导致处理不及时,一旦发生,后果往往是致命性的。因此,笔者在文献复习的基础上,结合国内外甲状腺外科的临床进展,对完全腔镜甲状腺手术中少见并发症的发生原因及其预防策略进行综述。

With over 22 years of continuous development and innovation,totally endoscopic thyroidectomy has proved to be safe and feasible,and its minimal invasiveness and cosmetic benefit are beyond doubt.However,due to the narrow operation space of complete endoscopic thyroidectomy,rich blood supply of the thyroid gland,and being adjacent to the recurrent laryngeal nerve,superior laryngeal nerve,parathyroid glands,trachea,esophagus,lymphatic vessels and other important tissue structures,a series of serious associated complications may easily arise from unskilled operation.Particularly,some rare complications with low incidence in clinical practice,not specifically described in textbooks and rarely reported in domestic and foreign literature,such as delayed hemorrhage,chyle leakage,esophageal and tracheal injury,pneumothorax,CO2 embolism,are often overlooked and this results in delays in treatment.Once they occur,however,the consequences are always extremely serious.Therefore,based on the review of the literature and in combination with the clinical progress of thyroid surgery at home and abroad,the authors address the causes and prevention strategies for the rare complications of totally endoscopic thyroid surgery.