经乳晕入路腔镜甲状腺切除术治疗男性患者的困难及对策

目的:探讨经乳晕入路腔镜甲状腺切除术(endoscopic thyroidectomy,ETE)治疗男性甲状腺疾病患者的困难与处理措施。方法:回顾分析2012年9月至2013年10月43例经乳晕入路行ETE的男性及175例女性良性甲状腺肿患者的临床资料,分析男性患者术中的主要难点及处理措施。结果:218例手术均获成功,手术方式包括单侧次全或近全切除,单侧腺叶切除,双侧次全或近全切除、全切除术,两组间手术方式差异均无统计学意义(P>0.05)。男性患者手术时间、术中出血量、术中丝线悬吊腺体的比率均高于女性患者(P<0.05);两组患者住院时间差异无统计学意义(P>0.05)。两组均无喉返神经损伤或其他并发症发生。结论:经乳晕入路ETE治疗男性良性甲状腺肿的手术难度较女性患者大,主要原因在于男性胸壁移动性较小及发达的颈前肌群导致腺体向后延伸生长,从而使腺体的显露、手术操作在灵活性上受到一定限制。术前B超、CT平扫三维成像检查利于术者评估所需的手术空间,术中丝线悬吊腺体可在尽量避免切断颈前肌群的情况下有效降低手术难度,降低中转开放手术的风险。

The difficulties and the countermeasures of endoscopic thyroidectomy via areola approach for male patients

Objective： The aim of this study was to evaluate the difficulties and explore the countermeasures of endoscopic thyroidectomy（ ETE） via the areola approach for male patients with thyroid goiters. Methods： The clinical data of 43 male and 175 female patients with benign thyroid goiters who underwent ETE via the areola approach between Sep. 2012 and Oct. 2013 were analyzed retrospectively,the difficulties and the countermeasures during the operation of male patients were evaluated. Results： The surgery was successfully completed in 218 cases（ 100%）. Of these patients,unilateral subtotal or near-total thyroidectomy,unilateral lobectomy,bilateral subtotal or near-total thyroidectomy or total thyroidectomy was preformed,and there was no significant difference in these surgical methods between male and female patients（ P 〉0. 05）. The operation time,blood loss and ratio of suspending the thyroid gland with silk of male patients were higher than the female patients（ P 〈0. 05）. There were no differences in the hospital stay after surgery between them（ P 〉0. 05）. There were no recurrent laryngeal nerve（ RLN） injury or other complications. Conclusions： The difficulty of ETE via areola approach for male patients is higher than the female patients,the main reasons for this are the mobility of the chest wall of male patients is less than that of females and the strong anterior cervical muscle groups often make the thyroid gland extend backward,which restricts the exposure of the thyroid gland and the flexibility of the operations. Preoperative B ultrasound and CT scan can help to access the appropriate working space,suspension of the thyroid gland with silk thread can significantly reduce the difficulty of the surgery and the risk of conversion to open surgery without cutting off the anterior cervical muscle group.