无充气腋窝入路腔镜下甲状腺手术中经胸大肌肌间隙寻找胸锁乳突肌的应用价值

The value of searching for the sternocleidomastoid muscle through the pectoralis major muscle gap in the endoscopic thyroidectomy by gasless unilateral axillary approach

目的探索胸大肌形态学特征及毗邻结构的解剖关系,研究通过胸大肌肌间隙寻找胸锁乳突肌的路径。方法选取2020年12月至2022年9月在安徽理工大学第一附属医院和中国科学技术大学附属第一医院行甲状腺手术156例甲状腺乳头状癌患者,常规行无充气腋窝入路腔镜下甲状腺手术为A组,在此基础上通过胸大肌肌间隙寻找胸锁乳突肌为B组,每组各78例。结果B组78例中寻找到典型胸大肌肌间隙共71例(91%),未能寻找到的7例(9%)。胸大肌锁骨部与胸肋部间隙的形态学分为3型:分隔明显型(Ⅰ型)、分隔不明显-部分重叠型(Ⅱa型)、分隔不明显-完全吻合型(Ⅱb型)。B组平均手术时间为(105±15)min,少于A组的(156±27)min,差异有统计学意义(t=14.523,P<0.01);B组术后1 d引流量为(49±6)ml,少于A组的(51±6)ml,差异有统计学意义(t=2.273,P=0.024)。两组患者的术中出血量、术后住院时间及并发症发生率相比差异均无统计学意义(t=0.557,P=0.578;t=0.134,P=0.894;χ^(2)=1.844,P=0.174)。结论在无充气腋窝入路完全腔镜下甲状腺手术中通过胸大肌肌间隙寻找胸锁乳突肌可缩短手术时间、提高手术效率。

Objective To explore the morphological characteristics of the pectoralis major muscle and the anatomical relationship of adjacent structures.Methods A total of 156 patients undergoing thyroid surgery at the First Hospital of Anhui University of Science&Technology and the First Affiliated Hospital of University of Science and Technology of China from Dec 2020 to Sep 2022 were includeed.Those adopting routine endoscopic thyroidectomy by gasless unilateral axillary approach were assigned to group A,and searching for the sternocleidomastoid muscle through the pectoralis major muscle gap on this basis to group B.Results Among the 78 patients in group B,a total of 71(91%)cases were found to have a typical sternocleidomastoid muscle gap,and in 7(9%)cases were not found.The morphology phenotypes of the gap between the clavicular part and thoracic ribs part of the pectoralis major muscle was found in 3 types:obvious separation type(typeⅠ),inconspicuous separation-partially overlapped type(typeⅡa),and inconspicuous separation-completely anastomosed type(typeⅡb).The mean duration of surgery in group B was less(105±15)min than that in group A(156±27)min(t=14.523,P<0.01);postoperative one day drainage in group B was less(49±6)ml than that in group A(51±6)ml(t=2.273,P=0.024).There was no statistically significant difference in intraoperative bleeding,postoperative hospital stay and complication rate between the two groups(t=0.557,P=0.578;t=0.134,P=0.894;χ^(2)=1.844,P=0.174).Conclusion The search for the sternocleidomastoid muscle through the pectoralis major muscle gap in the endoscopic thyroidectomy by gasless unilateral axillary approach can shorten the duration of surgery and improve the efficiency of surgery.