乳晕入路内镜下甲状腺切除术操作空间建立的研究

目的探讨在乳晕人路内镜下甲状腺切除术中建立操作空间的解剖平面。方法2012年6—12月45例行乳晕人路内镜下甲状腺切除术，注水针顶住胸骨柄在胸大肌浅筋膜的深面注射膨胀液，经胸骨上间隙进入颈深筋膜浅层后方建立操作空间。结果45例手术操作成功，分离操作空间的时间平均为6．8min（4～12min）。无神经及甲状旁腺损伤；无一例术后要求药物止痛；无皮肤灼伤、皮下瘀斑、皮下积液、颈部皮肤麻木；2例皮下脂肪液化经换药术后2周内治愈。术后颈部皮瓣水肿表现为胸骨上凹消失（38例）或隆起（7例），1个月后均恢复正常，43例随访6～12个月，平均7．3月，诉颈部和胸壁皮肤绷紧感分别有24例和3例，在术后3～6个月内消失。结论在乳晕人路内镜下甲状腺切除术中，经胸大肌浅筋膜深面进入颈深筋膜浅层后方的方法建立操作空间简单、快速、暴露好，术后疼痛轻，皮肤并发症少。

Operating Space of Endoscopic Thyroidectomy via Breast Areola Approach

Objective To investigate the anatomical plane of the operating space in endoscopic thyroidectomy via breast areola approach. Methods A total of 45 patients underwent endoscopic thyroidectomy through breast areola approach between June 2012 and December 2012. Expansion liquid was injected near the sternum beneath the deep layer of superficial fascia of pectoralis major and operating space was established behind the investing layer through suprasternal space. Results All the 45 operations were performed successfully. The time for separating neck operating space was 6.8 min （range, 4 - 12 min）. No nerve and parathyroid injury, subcutaneous hydrops, ecchymosis, skin burn or neck skin numbness occurred. Two patients underwent fat liquefaction and recovered in 2 weeks. Edema of neck skin flap presented as the disappearance of suprasternal notch （38 eases） or elevation （7 cases）. No skin numbness occurred. During the follow-up （range, 6 -12 months; average, 7.3 months） of 43 patients, 24 and 3 patients complained of taut-feeling of cervical and chest wall skin respectively and the symptoms disappeared 3 to 6 months after operation. Conclusions In endoscopic thyroidcctomy through breast areola approach, establishing operating space underneath the investing layer and behind the deep layer of pectoral fascia is fast and simple. It has the advantages of good exposure, less postoperative pain, and less skin complications.