胸骨前径路腔镜甲状腺手术的临床应用

目的：探讨胸骨前径路腔镜甲状腺手术的临床应用价值。方法：于胸骨切迹下10cm处建立观察孔,双侧锁骨中线乳头上方5cm处建立操作孔,行腔镜甲状腺手术治疗甲状腺良性疾病58例,回顾分析其临床资料。结果：54例在腔镜下完成,4例中转常规手术。手术种类包括腔镜甲状腺瘤切除术38例、单侧甲状腺大部切除术14例,双侧甲状腺次全切除术2例,平均手术时间134min（115～230min）,出血量26ml（5～80ml）,术后住院时间4.6d（3～7d）。皮下气肿1例,皮下淤血4例,颈前区不适感2例,均于1月内消失;所有患者对美容效果满意,随访8～38个月,2例结节性甲状腺肿患者术后复发,目前仍继续观察,甲亢患者甲状腺功能正常。结论：胸骨前径路腔镜甲状腺手术在保证美容效果的同时,进一步减小了患者的创伤,具有经济、安全、有效等优点,值得临床推广。

Clinical application of endoscopic thyroidectomy by anterior chest approach

Objective: To explore the value of endoscopic thyroidectomy by anterior chest approach in the treatment of thyroid diseases.Methods:Retrospectively analysed the clinical data of 58 patients with benign thyroid diseases undergone endoscopic thyroidectomy,in which the observation port was made about 10cm beneath the sternal notch and the operation ports about 5cm above the nipples on midclavicular line.Results:Except that 4 patients were converted to traditional operations,54 patients received complete endoscopic procedure,including endoscopic adenoma resection(38 cases),unilateral subtotal thyroidectomy(14 cases),and bilateral subtotal thyroidectomy(2 cases).The mean operative time was 134min(range,115-230min);mean blood loss was 26ml(range,5-80ml);and mean postoperative hospitalization was 4.6d(range,3-7d).1 case was complicated with subcutaneous emphysema,4 cases with subcutaneous ecchymosis,and 2 cases with paraesthesia of anterior neck region,but all disappeared in less than 1 month.All the patients were satisfied with the cosmetic effect.With a follow-up of 8-38 months,only 2 patients with nodular goiter recurrented who are still under observation,and the thyroid function of the patients with hyperthyroidism are normal.Conclusions:Endoscopic thyroidectomy by anterior chest approach not only has satisfied cosmetic effect,but also reduces the operative trauma.Combined with the advantages of economic,safe and effective,it is worth being promoted clinically.