三维B超定位图指导内镜甲状腺手术治疗结节性甲状腺肿的探讨

目的：探讨在结节性甲状腺肿的内镜手术治疗中，三维B超定位图及手术技巧的意义。方法：32例结节性甲状腺肿患者施行乳晕人路内镜下甲状腺切除术，术前B超定位病灶并标记于自行设计的三维定位图上，术中从下极开始充分暴露腺体，根据定位图保留Berry韧带平面或（和）上极腺体。结果：根据B超定位单侧病变有15例，其中3例行腺叶切除术；双侧病变17例，12例行次全切除术，5例行一侧腺叶部分切除加一侧腺叶切除。无中转开放手术病例，无术后并发症，术后复查无漏切结节。结论：术前三维B超定位图及术中相应的操作技巧，有助于内镜甲状腺手术彻底的切除结节性甲状腺肿的多发病灶。

Three-dimensional ultrasound locatization in endoscopic thyroidectomy for multinodular goiter

Objective： To explore the three-dimensional ultrasound locatization in endoscopic thyroidectomy （ET） for multinodular goiter（MG）. Method：Thirty two patients with MG underwent ET via bilateral areolar ap- proach. Preoperative uhrasonography were used to locate lesions and marked in the 3-D map designed by us. Dur ing ET procedure, surgery skills were adopted to expose inferior pole of thyroid, glands in the area of Berry liga- ment or （and） upper pole were retained according to the preoperative location map. Result： According to the preop- erative ultrasonic orientation, 3 lobectomy were performed in 15 cases of unilateral lesions, 12 subtotal thyroidec- tomy were performed in 17 cases of bilateral lesions, and 5 patients performed unilateral lobectomy add partial thy- roidectomy. All patients had successful ET using bilateral areola approach. No conversions to open surgery, no complication occurred, and no nodules were found missing in the postoperative ultrasonography examinations. Con- clusion：Preoperative ultrasonic orientation and intraoperative operating skills are contributing to a successful ET for MG.