免充气锁骨下入路腔镜甲状腺手术治疗良性甲状腺肿瘤临床分析

Clinical analysis of benign thyroid tumors treated by endoscopic thyroidectomy of inflatable subclavian approach

目的 探讨免充气锁骨下入路治疗良性甲状腺肿瘤的安全性及可行性。方法 回顾性分析接受免充气锁骨下入路治疗甲状腺肿瘤的患者36例临床资料,记录手术时间、出血量、肿瘤大小、术后喉返神经损伤率、住院时间、颈部吞咽功能障碍等指标。所有患者通过门诊随访。结果 36例患者均经腔镜下完成手术切除,无中转开放病例。肿瘤最大直径6 cm(为囊实性肿瘤,囊性成分占40%),最小直径4.1 cm,平均直径4.6 cm(4.1~6 cm);手术时间为84 min(50~110 min),平均出血量65 mL(20~120 mL),术后暂时性喉返神经损伤1例,永久性损伤0例,住院时间6 d(4~8d)。颈部吞咽功能障碍1例。无术后出血再次手术病例。结论 免充气经锁骨下入路腔镜甲状腺切除术对于4 cm以上肿瘤效果安全可行。

Objective To investigate the safety and feasibility of the treatment of benign thyroid tumors by endoscopic thyroidectomy of inflatable subclavian approach.Methods 36 patients with thyroid tumor treated by inflatable subclavian approach were retrospectively analyzed. The clinical data, the operative time, the amount of bleeding, the size of tumor, the postoperative recurrent laryngeal nerve injury rate, the length of hospital stay, and indicators of cervical dysphagia were recorded and analyzed. All patients were followed up through outpatient service.Results 36 patients were resected by endoscopic surgery, and no patient was converted to open surgery. The maximum diameter of the tumor was 6 cm(cystic and solid tumor, 40% of the volume was cystic),and the minimum diameter of the tumor was 4.1 cm. The mean diameter was 4.6(4.1~6) cm, the operation time was 84(50~110) minutes, the average bleeding volume was 65(20~120) ml, there was 1 case of temporary recurrent laryngeal nerve injury and 0 case of permanent injury, the hospital stay was 6(4~8) days,and 1 case of dysphagia. There was no postoperative bleeding and reoperation. Conclusion Endoscopic thyroidectomy via subclavian approach without air inflation is safe and feasible for resection of tumors over 4 cm. The cosmetic effect is better than open surgery.