【摘要】 目的:探讨内镜技术用于甲状腺手术的可行性、技术难点及解决方法。方法:回顾分析2006年10月至2008年7月我院为128例患者行内镜甲状腺手术的临床资料。结果:128例中122例内镜手术成功,6例中转手术,其中2例为Ⅲ度甲亢,颈部操作空间不够;4例游离甲状腺肿瘤时引起难以控制的出血。手术时间48～240min,平均85min。术中平均出血15ml。颈部引流管术后3d拔除,术后4d出院。6例皮下积液,2例皮下气肿,2例皮下瘀斑,2例颈部感觉减退,3例吞咽不适,经对症处理很快康复。未损伤喉上神经、喉返神经及甲状旁腺。随访122例6～9个月,无一例复发。患者对术后美容效果非常满意。结论:内镜甲状腺手术出血少,并发症发生率低,具有颈部无瘢痕、美容效果极佳、安全可靠的优点。操作空间的建立,手术视野、甲状腺及肿瘤的良好显露,残留甲状腺体积的正确估计,超声刀的熟练运用,出血的处理及颈前肌群的熟练缝合是手术的关键。更多还原

【Abstract】 Objective:To investigate the feasibility,key technique difficulties and its solution of endoscopic thyroidectomy through anterior chest and breast approach.Methods:A retrospective analysis was made on the clinical data of 128 cases,who were treated with endoscopic thyroidectomy from Oct.2006 to Jul.2008.And the safety,indication,contraindication,the key technique difficulties and its management of the operation were discussed.Results:Of 128 cases,operations were successfully performed in 122 cases and 6 cases were converted to conventional thyroidectomy because of 4 cases of hemorrhage and 2 cases of large thyroid gland.Besides,the operation time was 48-240min(mean 85min),and the average of intraoperative blood loss was 15ml.Patients got rid of the drainage tubes after 3 postoperative days and were discharged from the hospital after 4 postoperative days.The postoperative complications included subcutaneous hydrops in 6 cases,subcutaneous emphysema in 2 cases,the neck region ecchymosis in 2 cases,jugular hypesthesia in 2 cases,and discomfort at swallowing in 3 cases.All of the patients suffered from complications were treated by symptomatic management and recovered soon.However,there were no other complications such as postoperative bleeding,the hoarse,the injury of the superior laryngeal nerve,recurrent laryngeal nerve and parathyroid gland.And no recurrence was found in 122 cases by following up 6-9 months(mean,6 months),all patients were satisfied with the cosmetic effect of the operation.Conclusions:Endoscopic thyroidectomy leads to little blood loss,mild postoperative pain,little complication,satisfactory cosmetic effect with no scars in the neck region,and is suggested as a feasible and safe procedure.The key technique of operation is to keep the adequate operative space,the clear exposure of the thyroid gland and neoplasm,to manage the bleeding,estimate the residual quantity of thyroid gland,proficient manipulation of ultrasound knife and suture of the anterior cervical muscles.更多还原