免充气经腋窝入路腔镜下甲状腺乳头状癌根治术22例报告

Gasless transaxillary endoscopic radical thyroidectomy for papillary thyroid carcinoma:A 22-case report

目的介绍免充气经腋窝入路腔镜下甲状腺乳头状癌根治术的临床经验。方法回顾性分析2020年10月-2022年1月共22例经腋窝入路腔镜下甲状腺乳头状癌手术的临床资料。采用患侧腋窝作切口建立皮下隧道,经皮肤外悬吊器械作为牵引,以此来创造操作空间。分离并切除该侧甲状腺腺叶及峡部,同时完成中央区淋巴结(VI区淋巴结)的清扫。结果22例患者均顺利完成经腋窝入路腔镜甲状腺手术。2例患者术后第二天复查甲状旁腺激素(Parathyroid Hormone,PTH)<15 ng/L,余20例在正常范围内(15~65 ng/L)。1例患者术后第二天复查血钙<2.11 mmol/L,余21例在正常范围内(2.11~2.52 mmol/L)。所有患者均无术后出血、喉返神经损伤引起的声音嘶哑、低钙引发的麻木抽搐及乳糜漏等并发症。结论免充气经腋窝入路腔镜甲状腺手术安全、可行。

Objective To introduce the clinical experience of gasless transaxillary endoscopic radical thyroidectomy for papillary thyroid carcinoma.Methods From October 2020 to January 2022,the clinical data of 22 patients with thyroid papillary carcinoma undergoing endoscopic surgery via axillary approach were retrospectively analyzed.A subcutaneous tunnel was established by using the axillary incision of the affected side,and the external hanging device was used as traction to create the operation space.The thyroid gland lobes and isthmus were separated and excised,and the central neck lymph nodes(level VI lymph nodes)were cleaned.Results All 22 patients successfully completed endoscopic thyroidectomy via axillary approach.Parathyroid hormone(PTH)level was<15 ng/L in 2 patients on the second day after operation,and those of the other 20 patients were within the normal range(15~65 ng/L).One patient had blood calcium<2.11 mmol/L on the second day after operation,and the rest 21 patients had normal range(2.11~2.52 mmol/L).All patients had no complications such as postoperative hemorrhage,hoarseness caused by recurrent laryngeal nerve injury,numbness and convulsion caused by low calcium and chylous leakage.Conclusion Endoscopic thyroidectomy via axillary approach is safe and feasible.