减少皮下分离的直线型隧道在经胸壁入路腔镜甲状腺切除术中的应用

摘要

目的 探讨经胸壁入路腔镜甲状腺切除术中直线型隧道的应用价值.方法 2008年3月～ 2011年6月,胸壁三孔入路行腔镜甲状腺切除术40例,术前诊断:结节性甲状腺肿20例,甲状腺腺瘤16例,甲状腺钙化灶4例.在游离皮瓣时,采用金属棒朝颈部方向直行分离,形成直线型隧道,在良好的视野下完成腔镜甲状腺手术的过程.结果 40例均于腔镜下完成手术,其中行甲状腺次全切除(单侧)28例,甲状腺切除术(单侧)5例,双侧甲状腺部分切除术5例,甲状腺癌根治术2例(此2例术中快速病理报告为甲状腺未分化癌和滤泡状癌).手术时间(78.5±18.6)min,术中出血(40.2 ±15.6)ml,术中游离皮瓣时间(14.3±3.8)min,甲状腺肿瘤直径(3.8±2.5)cm.术后24～48 h拔除引流管,术后住院(3.5±2.0)d.1例术后声音嘶哑,3个月内恢复.2例术后一过性低钙,自行恢复.未发生皮下积液和血清肿.随访12 ～36个月,平均28个月,未发现复发.术后3个月1例胸部麻木感.美观满意度调查,32例十分满意,8例满意.结论 腔镜甲状腺手术中应用直线型隧道创伤小,减少血清肿和皮肤挛缩,操作易掌握,是一种安全可行的方法.%Objective To explore the value of straight line tunnel application in transthoracic laparoscopic thyroidectomy.Method 40 patients were given 3 ports transthoracic laparoscopic thyroidectomy from March 2008 to June 2011.Preoperative diagnosis:20 cases were nodular goiter,16 cases were adenoma and 4 cases were thyroid calcification.The metal rod was used to free the flap in a straight way toward the neck,and a straight line tunnel was created.The endoscopic thyroid operation was performed with good view.Results Laparoscopic thyroidectomy was performed on 40 cases successfully,including 28 subtotal resection (one side),5 resection (one side),5 double-side partial thyroidectomy and 2 thyroid cancer radical mastectomy.The 2 cases were reported as anaplastic thyroid carcinoma (ATC) and follicular thyroid carcinoma during operation and thyroid cancer radical mastectomy was performed.Operation time was (78.5-± 18.6) min,intraoperative blood loss was (40.2 ± 15.6) ml,intraoperative flap-freeing time was (14.3 ±3.8) min and the diameter of thyroid tumor was (3.8±2.5) cm.The drainage tubes were removed 24-48 hours after the surgery.Postoperative hospital stay was (3.5 ± 2.0) d.1 patient got voice hoarseness and recovered in 3 months.2 patients suffered from transient hypocalcemia and recovered without treatment.No subcutaneous effusion and seroma occurred.No recurrence was found during the follow-up of 12-36 months (mean,28 months).1 patient felt chest numbness 3 months after the surgery.32 patients were very satisfied with the cosmetic appearance and 8 patients were satisfied.Conclusions The application of straight line tunnel in laparoscopic thyroidectomy leads to small trauma,less seroma and skin contraction.It can be considered as a simple,safe and feasible procedure.