经腋窝入路无充气腔镜甲状腺切除82例诊治体会

目的评估腋窝入路无充气腔镜甲状腺切除手术的临床疗效。方法回顾性分析2019年2月至2022年10月间浙江省中医院甲状腺外科组收治的甲状腺结节或经穿刺明确为甲状腺恶性肿瘤并行经腋窝入路无充气腔镜甲状腺切除术患者的临床资料。为探索该术式的临床掌握度,选择由同一医师最初完成的47例手术相关资料,按手术时间对病例排序后,以手术时间为参数分析并绘制学习曲线,比较学习曲线两个阶段的手术时间、术中出血量、住院时间等临床资料的差异。结果82例手术均顺利完成。平均手术时间(127.5±36.0)min;平均术中出血量(15.5±6.3)mL;住院时间4~14 d,平均7 d;平均术后引流量(238±87)mL。学习曲线以第17例为界划分为学习阶段和掌握阶段,掌握阶段手术时间及住院时间短于学习阶段(P<0.05),术中出血量等差异无统计学意义(P>0.05)。结论经腋窝入路腔镜甲状腺手术在有效治疗甲状腺疾病的同时,避免了颈部疤痕,保护该解剖区域的感觉运动功能。经过17例无充气腋窝入路腔镜手术的学习后,术者的操作趋于稳定。

Objective To investigate the effect of endoscopic gasless axillary approach to the thyroidectomy.Methods A total of 82 patients with abnormal examination results in thyroid who underwent thyroidectomy via endoscopic gasless axillary approach in Zhejiang Provincial Hospital of Traditional Chinese Medicine from February 2019 to October 2022 were selected for a retrospective review.To explore the learning curve of this approach,operation time was ranked by chronological order and analyzed through method of cumulative summation(CUSUM).The results were divided into two different stages whose datas such as the operative time,intraoperative blood loss,postoperative hospital stay were then compared.Results All the operations were successfully completed.The average of operation time was(127.5±36.0)min,the average of intraoperative blood loss was(15.5±6.3)mL.The total hospital stay was 4~14 d,with an average of 7 d.The average of total postoperative drainage volumn was(238±87)mL.The learning phase and the mastering phase were divided by case 17.The operative time and total hospital stay of mastering stage group were evidently shorter than the ones in learning stage,other datas shown no differences.Conclusion Endoscopic thyroidectomy through gasless axillary approach is a good method both in treating thyroid diseases and protecting the motor and sensory functions in anterior cervical area by avoiding scars and lessening the damage.The surgery reaches stable stage at the case of 17.