免充气腔镜器械在经全乳晕入路腔镜甲状腺手术中的应用

Application value of non-inflating endoscopic instrument in endoscopic thyroid surgery through the whole areola approach

目的:探讨内撑式免充气建腔器械设计和在经全乳晕入路腔镜甲状腺手术临床应用的可行性、安全性。方法:回顾性分析20例甲状腺肿瘤病人的临床资料,使用研究团队研发的建腔器械实施免充气经全乳晕入路腔镜甲状腺手术,并分析相关临床指标。结果:20例病人均顺利完成手术,无中转。术后病理证实甲状腺微小乳头状癌18例,良性甲状腺结节及病变2例;行单侧腺叶切除2例,单侧腺叶+峡部+中央区清16例,双侧侧腺叶+峡部+中央区清2例。手术时间(120.50±40.62)min;中央区淋巴结清扫数目(6.32±3.00)个;术后拔管时间(3.68±2.34)d;术后喉返神经麻痹1例;术后穿刺隧道出血1例,局部加压包扎后停止;术后低钙抽搐1例,3 d后缓解;手术满意度(8.28±1.42)分。结论:内撑式免充气腔镜辅助甲状腺手术临床可行,安全性类似于CO_(2)充气手术,操作简化,同时有降低医疗成本和麻醉风险优势,值得进一步开发和应用。

Objective:To investigate the feasibility and safety of the design of the internal support apparatus in endoscopic thyroid surgery via whole areola approach.Methods:The clinical data of 20 patients with thyroid tumor were retrospectively analyzed.The patients were treated with non-inflatable areola approach endoscopic thyroidectomy using modified cavity construction instrument,and the relevant clinical indicators were analyzed.Results:Twenty patients were successfully operated,and not be transfered.The results of postoperative pathology showed that 18 cases were minimal papillary carcinoma of thyroid,and 2 cases were benign thyroid nodules.The unilateral lobotomy was performed in 2 cases,the unilateral glandular leaf+isthmus+central area were cleared in 16 cases,and the bilateral lateral glandular leaves+isthmus+central area were cleared in 2 cases.The operation time was(120.50±40.62)min,the number of central lymph nodes dissected was(6.32±3.00),and the postoperative extubation time was(3.68±2.34)days.One case with recurrent laryngeal nerve palsy after operation was found.The postoperative puncture tunnel bleeding in 1 case was stopped after local pressure dressing.The postoperative hypocalcium convulsions in 1 case was relieved 3 days later.The surgical satisfaction was(8.28±1.42)point.Conclusions:The internal support free air-filling endoscope in assisting thyroid surgery is feasible,similar to that of CO_(2) and simple to operate.It can reduce medical cost and anesthesia risk,which is worthy of further exploration.