摘要
目的:探讨经胸乳入路行内镜手术治疗甲亢的技术难点及疗效。方法:2006年10月至2011年2月为66例甲亢患者在全麻下经胸乳入路行内镜双侧甲状腺次全切除术。第1穿刺孔(观察孔,长1 mm)位于两乳头连线水平,用于置入内镜镜头;另两个穿刺孔(操作孔,长5 mm)分别位于左、右乳晕边缘,用于置入无创抓持钳和超声刀。用CO2气体维持颈部操作空间,压力维持在7 mmHg以下。用超声刀分离颈部手术操作空间、暴露甲状腺及血管,行甲状腺次全切除术。甲状腺组织装入标本袋经观察孔取出。缝合颈前肌群,甲状腺残腔放置引流管,经一侧乳晕处操作孔引出。结果:60例成功完成内镜手术,中转传统手术6例。手术时间80～240 min,平均95 min,术中出血量10～80 ml,平均30 ml,颈部引流管术后2～3 d拔除,术后住院3～6 d,平均4 d。手术均未损伤喉上神经、喉返神经及甲状旁腺。术后随访6～48个月,3例于术后3个月甲亢症状复发,采用放射碘131治愈;10例发生暂时性甲状腺功能轻度低下,未服用优甲乐药物,3个月后甲状腺功能恢复正常;4例发生甲状腺功能低下,3个月仍未恢复正常功能,需口服优甲乐50～75 mg。术后患者均对美容效果满意。结论:经胸乳入路行内镜手术治疗甲亢安全可行,疗效确切,患者创伤轻,美容效果好。
Objective：Tn investigate the teehnique diffieuhies and its therapeutic effect of endoscopic subtntal-thyroideetnmy tbr hyperlhymidisnl via anterior chest and breast apprnaeh. Methods： From Oet. 2006 to Feb. 2011,66 patients were give, endnseopie bilateral subtotal thyrnideetomy by the breast approach under general anesthesia. The subcutaneous space in the anterior chest was bluntly dissociated thrnugh a 10 mm incision between the nipples,and CO, was insuffiated at 7 mmHg to create the nperative spaee. The other two Troears were inserted in the mammary areola margin,and disseetiml of the thyroid and division of the thyroid vessels and pa- renchyma were pedbrmed endoseopieally using an ultrasnnicallv activated scalpel. The tumor was heht steady in the specimen bag aml taken out from endoseope portal. Anterior thyroid museles were sutured,and drainage tube was placed. Results：Sixty cases of 66 npera- lions were successfully performed. 6 cases were ennverted to conventional thyroideetnmy. The operatinn time was 80-240 rain （ mean 95 rain） , and the intraoperative mean blond loss was 30 m] （ 10-80 ml ）. The drainage tube was removed 2-3 days and patients were dis- eharged from the hospital mean 4 days（3-6 days） after operation. There was no other enmplieation sueh as the injulw of the superior and reetnTent laryngeal nmwe and parathyroid. All patients were fnHowed up fi）r 6-48 months ：3 eases recurred after 3 months, which was lat- er cured with radioiodine;10 eases of temporary hypothyroidism needed not to take medlcine;4 eases needed medicine-therapy after 3 n,mlhs. All patients were satisfied with the cosmetic results. Conclusions： Endoscopic subtotal-thyroideetomy for hyperlhyroidism is safe, feasible,mini-invasive with ta.vnrable cosmetic ettect.
出处
《腹腔镜外科杂志》
2011年第11期804-806,共3页
Journal of Laparoscopic Surgery
