【摘要】 目的 探讨无充气腋窝入路腔镜甲状腺手术空间体系构建的关键技术及临床效果，以期优化手术流程，缩短学习曲线，降低手术并发症的风险。方法 回顾性分析2018年8月—2023年1月在衡水市第四人民医院接受无充气腋窝入路腔镜甲状腺手术的36例患者，详细记录其手术的临床数据、手术时间、并发症及美容效果。总结胸锁乳突肌间隙寻找的有效方法，并创新性地提出“5～8时钟定位法”用于喉返神经精准定位。结果 36例患者手术均顺利完成，无中转开放手术。手术时间60～235 min,平均手术时间159.4 min,平均出血量17.2 mL,术后住院时间5～7 d。术后并发症发生率13.9%(5/36),其中出现短暂性喉返神经损伤1例，声音低沉2例，皮下积液2例。美容满意度100.0%。病理结果显示36例患者中单侧甲状腺乳头状癌15例，甲状腺腺瘤出血囊性变10例，结节性甲状腺肿伴腺瘤增生11例。15例甲状腺乳头状癌患者随访6～12个月无复发、转移。结论 通过无充气腋窝入路腔镜甲状腺手术空间体系构建，采用“5～8时钟定位法”显著提高了喉返神经的识别和保护效率，减少了神经损伤的风险。优化手术流程、降低并发症发生率，缩短学习曲线，为复杂腔镜手术提供了可推广的标准化技术框架。更多还原

【Abstract】 Objective To systematically explore the key techniques and clinical outcomes of constructing the spatial system for endoscopic thyroidectomy by gasless unilateral axillary approach(GUA), optimize the surgical procedure, shorten the learning curve, and reduce the risk of surgical complications.Methods A retrospective analysis was conducted on 36 patients who underwent gasless endoscopic thyroid surgery via the axillary approach at Hengshui Fourth People’s Hospital between August 2018 and January 2023. Detailed records of clinical data, operative time, complications, and cosmetic outcomes were maintained. The study summarized effective methods for identifying the sternocleidomastoid muscle space and innovatively proposed the “5-8 o’clock positioning technique” for precise localization of the recurrent laryngeal nerve.Results All 36 surgeries were successfully completed without conversion to open surgery. The operative time ranged from 60 to 235 minutes, with an average of 159.4 minutes. The average blood loss was 17.2 mL, and the postoperative hospital stay was 5-7 days. Pathological results revealed: 15 cases of unilateral papillary thyroid carcinoma, 10 cases of thyroid adenoma with hemorrhagic cystic degeneration, and 11 cases of nodular goiter with adenomatous hyperplasia. The complication rate was 13.9%(1 case of transient recurrent laryngeal nerve injury, 2 cases of hoarseness, and 2 cases of subcutaneous effusion). The cosmetic satisfaction rate was 100%. Follow-up of 15 papillary thyroid carcinoma patients for 6-12 months showed no recurrence or metastasis.Conclusions This study investigated the construction of the spatial system in 36 cases of gasless transaxillary approach thyroid surgery. The use of the “5-8 o’clock positioning technique” significantly improved the identification and protection efficiency of the recurrent laryngeal nerve, reducing the risk of nerve injury. The optimization of the surgical procedure, reduction in complication rates, and shortening of the learning curve provide a standardized technical framework that can be widely applied to complex endoscopic surgeries.更多还原