经胸壁入路腔镜甲状腺手术的应用体会(附217例报告)

摘要

目的:探讨腔镜甲状腺手术的临床疗效及经胸壁入路的优势.方法:回顾分析2009年12月至2014年12月收治的217例腔镜甲状腺手术患者的临床资料.其中单侧病变155例,72例行甲状腺肿物切除术,83例行甲状腺次全切除术;双侧病变62例,21例行双侧甲状腺肿物切除术,13例行双侧甲状腺次全切除术,28例一侧行甲状腺肿物切除术,另一侧行甲状腺次全切除术.结果:3例甲状腺癌患者中转行开放根治术,余者均在腔镜下完成手术.术后出现颈前区肿胀23例,消肿治疗3～6d痊愈;抽搐7例,补钙1～3d缓解;声音嘶哑4例,1～3个月自愈.无血清肿、窒息等其他并发症发生.168例放置引流管,12～50 h拔除,引流量10～ 70 ml;术中出血量3～50 ml,手术时间33～ 135 min,术后住院2～7d.随访3～30个月,术后切口瘢痕小,无一例复发.结论:腔镜甲状腺手术安全、有效,临床疗效确切.经胸壁入路直线操作路径短,患者创伤小,出血少,美容效果好,值得优先选择.%Objective:To evaluate the advantages of transthoracic endoscopic thyroidectomy.Methods:Retrospective analysis was performed on clinical data of 217 patients who underwent endoscopic thyroidectomy from Dec.2009 to Dec.2014.In these 217 cases,155 cases were unilateral lesion,among which 72 cases underwent strumectomy and 83 cases underwent subtotal thyroidectomy.The rest 62 cases were bilateral,among which 21 cases underwent bilateral strumectomy,13 cases underwent bilateral subtotal thyroidectomy and 28 cases were performed strumectomy on one side and subtotal thyroidectomy on the other side.Results:Three patients,who were confirmed thyroid cancer by pathologic examination,were converted to radical open thyroidectomy.The rest patients underwent endoscopic operation.23 patients were found swelling in the anterior region of neck after surgery and cured after detumescence for 3-6 d;7 cases of convulsion were found and alleviated after calcium supplement for 1-3 d;4 patients showed hoarseness and healed after 1-3 months.No seroma,asphyxia or other complications occurred.Negative pressure drainage tube was placed in 168 cases,and removed after 12-50 h.The drainage volume was 10-70 ml.The blood loss was 3-50 ml.The operation time was 33-135 min.The postoperative hospital stay was 2-7 d.After a 3 to 30 months follow up,the scar was small and no recurrence was found.Conclusions:Endoscopic thyroidectomy is safe,effective and has a definite therapeutic effect.Because of the advantage such as short operation path,few trauma and bleeding,and satisfying cosmetic effect,endoscopic thyroidectomy via the breast approach is a preferred choice.