无充气腋窝入路完全腔镜下甲状腺手术意外出血的处理

Treatment of Accident Hemorrhage in Endoscopic Thyroidectomy Using the Gasless Unilateral Axillary Approach

目的探讨无充气腋窝入路全腔镜甲状腺手术意外出血的处理方法和特点。方法回顾性分析2019年10月~2021年10月无充气经腋窝入路全腔镜甲状腺手术110例资料,共发生意外出血9例(8.2%)。术中出血8例,出血量35~100 ml,使用超声刀凝固、血管夹或生物蛋白夹夹闭;术后出血1例,为胸壁血肿,出血量1440 ml,加压包扎及对症处理。结果9例均止血成功,无中转开放手术,无非计划再次手术。术中出血的血管为甲状腺下动脉分支1例,甲状腺最下动脉1例,颈外静脉属支2例,颈内静脉属支3例,颈前静脉1例;胸壁血肿1例为胸壁穿支血管出血。结论对于无充气腋窝入路全腔镜甲状腺手术意外出血,术中出血可及时采取凝闭、夹闭等措施妥善处理,术后出血不易引起气管压迫、窒息,可从容处理。

Objective To study the treatment and characteristics of accident hemorrhage in endoscopic thyroidectomy using the gasless unilateral axillary approach.Methods A total of 110 cases undergoing endoscopic thyroidectomy using the gasless unilateral axillary approach between October 2019 and October 2021 were reviewed retrospectively.Accident hemorrhage occurred in 9 cases(8.2%).Eight of them were found during the operation.The amount of bleeding was 35-100 ml.The hemostatic therapy was completed by using ultrasonic scalpel solidification,vascular clamping and biological protein clamping.Postoperative hemorrhage occurred in 1 case,which was a chest wall hematoma with a bleeding volume of 1440 ml.Pressure bandage and symptomatic treatment were performed.Results The hemorrhage was stopped successfully in all the 9 cases.No conversion to open surgery or unplanned reoperation was required.The location of bleeding was in the inferior thyroid artery branch in 1 case,arteria thyroidea ima in 1 case,vena jugularis externa branch in 2 cases,jugular vein branch in 3 cases,and anterior jugular vein in 1 case.One case of chest wall hematoma was bleeding from perforating vessels of chest wall.Conclusions For the accident hemorrhage in endoscopic thyroidectomy using the gasless unilateral axillary approach,measures such as coagulation and clamping can be taken in time to properly deal with the intraoperative bleeding.The postoperative bleeding is not prone to tracheal compression and asphyxia,which can be handled steady.