BACKGROUND Endoscopic thyroidectomy has obvious advantages over conventional surgical techniques in terms of postoperative cosmetic outcome.Although the incidence of carbon dioxide embolism(CDE)during endoscopic thyro...BACKGROUND Endoscopic thyroidectomy has obvious advantages over conventional surgical techniques in terms of postoperative cosmetic outcome.Although the incidence of carbon dioxide embolism(CDE)during endoscopic thyroidectomy is very low,it is potentially fatal.The clinical manifestations of CDE vary,and more attention should be paid to this disorder.CASE SUMMARY A 27-year-old man was scheduled for thyroidectomy by the transoral vestibular approach.The patient had no other diseases or surgical history.During the operation,he developed a CDE following inadvertent injury of the anterior jugular vein.The clinical manifestation in this patient was a transient sharp rise in end-tidal carbon dioxide,and his remaining vital signs were stable.In addition,loud coarse systolic and diastolic murmurs were heard over the precordium.The patient was discharged on day 4 after surgery without complications.CONCLUSION A transient sharp rise in end-tidal carbon dioxide is considered a helpful early sign of CDE during endoscopic thyroidectomy.展开更多
Advances in imaging for preoperative localization have propelled the widespread adoption of minimally invasive/focused parathyroidectomy in primary hyperparathyroidism.Though it is performed through a relatively small...Advances in imaging for preoperative localization have propelled the widespread adoption of minimally invasive/focused parathyroidectomy in primary hyperparathyroidism.Though it is performed through a relatively small incision,studies have shown that the presence of a neck scar increases attentional bias towards the neck resulting in compromised quality of life.Transoral endoscopic parathyroidectomy vestibular approach(TOEPVA)eliminates a neck scar.While indications for TOEPVA are the same as that of minimally invasive open parathyroidectomy,confident preoperative localization of the parathyroid with a surgeon performed ultrasound along with concordant localization with SPECT CT is an essential prerequisite before offering patients this approach for parathyroidectomy.Early data has demonstrated the feasibility and safety of this approach.展开更多
目的:分析经颏下前庭入路腔镜术式与胸乳入路腔镜术式在甲状腺单侧良性肿瘤切除术中的应用疗效。方法:选择2022年1月至2023年6月收治的44例行腔镜手术的单侧甲状腺肿瘤患者,按手术方式分为颏下前庭入路组(22例)与胸乳入路组(22例)。比较...目的:分析经颏下前庭入路腔镜术式与胸乳入路腔镜术式在甲状腺单侧良性肿瘤切除术中的应用疗效。方法:选择2022年1月至2023年6月收治的44例行腔镜手术的单侧甲状腺肿瘤患者,按手术方式分为颏下前庭入路组(22例)与胸乳入路组(22例)。比较2组手术相关指标、并发症发生率、疼痛程度、术后颈部舒适度、美容效果及主观满意度评分等。结果:颏下前庭入路组在降低手术时长、减少术中出血量、术后第1天引流量方面较胸乳入路组存在优势,差异有统计学意义(P<0.05)。2组在手术前后甲状旁腺素差值、血钙差值、术后总引流量、拔管时间、住院时间、肿瘤的病理性质、并发症发生率等方面比较差异无统计学意义(P>0.05)。在减少疼痛程度方面,颏下前庭入路组较胸乳入路组存在优势,2组术后6 h、24 h、72 h VAS疼痛评分比较差异有统计学意义(P<0.05)。2组术后患者主观颈部舒适度、主观满意度评分比较差异无统计学意义(P>0.05),但术后美容效果比较,颏下前庭组温哥华瘢痕评分优于胸乳入路组,差异有统计学意义(P<0.05)。结论:2种手术方式均安全可行,但在控制手术时长、减轻手术创伤、提高手术满意度方面,颏下前庭入路可能比胸乳入路具有优势。展开更多
目的对比不同术式治疗甲状腺微小乳头状癌(PTMC)的效果。方法回顾性分析2019年6月至2021年5月武汉科技大学附属武汉市武昌医院接收的择期手术治疗的PTMC病人157例,其中经口腔前庭入路腔镜甲状腺手术(TOETVA)组63例,行TOETVA,开放组94例...目的对比不同术式治疗甲状腺微小乳头状癌(PTMC)的效果。方法回顾性分析2019年6月至2021年5月武汉科技大学附属武汉市武昌医院接收的择期手术治疗的PTMC病人157例,其中经口腔前庭入路腔镜甲状腺手术(TOETVA)组63例,行TOETVA,开放组94例,行开放术式甲状腺手术。应用基线资料对病人进行1∶1倾向性评分匹配(PSM),最终纳入TOET⁃VA组、开放组各56例。比较两组围术期指标、血清指标、美观度及术后并发症发生率。结果TOETVA组手术用时[(65.03±5.25)min比(53.72±6.46)min]、住院时间[(7.25±1.46)d比(5.72±1.12)d]明显较开放组长(P<0.05),清扫中央区淋巴结(CLN)个数[(7.57±1.61)个比(6.36±1.48)个]明显较开放组多(P<0.05),术后引流量[(73.16±16.58)mL比(62.41±14.06)mL]明显较开放组大(P<0.05),术后24 h疼痛数字评分法(NRS)评分[(5.02±1.37)分比(6.24±1.50)分]明显较开放组低(P<0.05);TOETVA组术后24 h C反应蛋白(CRP)水平明显较开放组低(P<0.05),甲状旁腺激素(PTH)、白细胞(WBC)和开放组比较差异无统计学意义(P>0.05);TOETVA组温哥华瘢痕评定量表(VSS)评分为(2.05±0.61)分,明显较开放组的(5.23±0.87)分低(P<0.05);TOETVA组并发症发生率10.71%和开放组的17.86%比较差异无统计学意义(P>0.05)。结论和开放手术相比,TOETVA的手术用时及TOETVA病人住院时间更长,但其清扫CLN的效果更好,病人术后疼痛度更轻,且美观度更高。展开更多
基金Science and Technology Bureau of Shapingba District,Chongqing,China,No.JCD202041and Science and Technology Bureau of Chongqing,China,No.CSTC2019JXJL130029.
文摘BACKGROUND Endoscopic thyroidectomy has obvious advantages over conventional surgical techniques in terms of postoperative cosmetic outcome.Although the incidence of carbon dioxide embolism(CDE)during endoscopic thyroidectomy is very low,it is potentially fatal.The clinical manifestations of CDE vary,and more attention should be paid to this disorder.CASE SUMMARY A 27-year-old man was scheduled for thyroidectomy by the transoral vestibular approach.The patient had no other diseases or surgical history.During the operation,he developed a CDE following inadvertent injury of the anterior jugular vein.The clinical manifestation in this patient was a transient sharp rise in end-tidal carbon dioxide,and his remaining vital signs were stable.In addition,loud coarse systolic and diastolic murmurs were heard over the precordium.The patient was discharged on day 4 after surgery without complications.CONCLUSION A transient sharp rise in end-tidal carbon dioxide is considered a helpful early sign of CDE during endoscopic thyroidectomy.
文摘Advances in imaging for preoperative localization have propelled the widespread adoption of minimally invasive/focused parathyroidectomy in primary hyperparathyroidism.Though it is performed through a relatively small incision,studies have shown that the presence of a neck scar increases attentional bias towards the neck resulting in compromised quality of life.Transoral endoscopic parathyroidectomy vestibular approach(TOEPVA)eliminates a neck scar.While indications for TOEPVA are the same as that of minimally invasive open parathyroidectomy,confident preoperative localization of the parathyroid with a surgeon performed ultrasound along with concordant localization with SPECT CT is an essential prerequisite before offering patients this approach for parathyroidectomy.Early data has demonstrated the feasibility and safety of this approach.
文摘目的:分析经颏下前庭入路腔镜术式与胸乳入路腔镜术式在甲状腺单侧良性肿瘤切除术中的应用疗效。方法:选择2022年1月至2023年6月收治的44例行腔镜手术的单侧甲状腺肿瘤患者,按手术方式分为颏下前庭入路组(22例)与胸乳入路组(22例)。比较2组手术相关指标、并发症发生率、疼痛程度、术后颈部舒适度、美容效果及主观满意度评分等。结果:颏下前庭入路组在降低手术时长、减少术中出血量、术后第1天引流量方面较胸乳入路组存在优势,差异有统计学意义(P<0.05)。2组在手术前后甲状旁腺素差值、血钙差值、术后总引流量、拔管时间、住院时间、肿瘤的病理性质、并发症发生率等方面比较差异无统计学意义(P>0.05)。在减少疼痛程度方面,颏下前庭入路组较胸乳入路组存在优势,2组术后6 h、24 h、72 h VAS疼痛评分比较差异有统计学意义(P<0.05)。2组术后患者主观颈部舒适度、主观满意度评分比较差异无统计学意义(P>0.05),但术后美容效果比较,颏下前庭组温哥华瘢痕评分优于胸乳入路组,差异有统计学意义(P<0.05)。结论:2种手术方式均安全可行,但在控制手术时长、减轻手术创伤、提高手术满意度方面,颏下前庭入路可能比胸乳入路具有优势。
文摘目的对比不同术式治疗甲状腺微小乳头状癌(PTMC)的效果。方法回顾性分析2019年6月至2021年5月武汉科技大学附属武汉市武昌医院接收的择期手术治疗的PTMC病人157例,其中经口腔前庭入路腔镜甲状腺手术(TOETVA)组63例,行TOETVA,开放组94例,行开放术式甲状腺手术。应用基线资料对病人进行1∶1倾向性评分匹配(PSM),最终纳入TOET⁃VA组、开放组各56例。比较两组围术期指标、血清指标、美观度及术后并发症发生率。结果TOETVA组手术用时[(65.03±5.25)min比(53.72±6.46)min]、住院时间[(7.25±1.46)d比(5.72±1.12)d]明显较开放组长(P<0.05),清扫中央区淋巴结(CLN)个数[(7.57±1.61)个比(6.36±1.48)个]明显较开放组多(P<0.05),术后引流量[(73.16±16.58)mL比(62.41±14.06)mL]明显较开放组大(P<0.05),术后24 h疼痛数字评分法(NRS)评分[(5.02±1.37)分比(6.24±1.50)分]明显较开放组低(P<0.05);TOETVA组术后24 h C反应蛋白(CRP)水平明显较开放组低(P<0.05),甲状旁腺激素(PTH)、白细胞(WBC)和开放组比较差异无统计学意义(P>0.05);TOETVA组温哥华瘢痕评定量表(VSS)评分为(2.05±0.61)分,明显较开放组的(5.23±0.87)分低(P<0.05);TOETVA组并发症发生率10.71%和开放组的17.86%比较差异无统计学意义(P>0.05)。结论和开放手术相比,TOETVA的手术用时及TOETVA病人住院时间更长,但其清扫CLN的效果更好,病人术后疼痛度更轻,且美观度更高。
