经胸乳途径行腔镜甲状腺手术的临床体会

目的:探讨经胸乳途径行腔镜甲状腺手术的可行性及临床疗效。方法:回顾分析2006年10月至2016年10月为2 095例患者经胸乳途径行腔镜甲状腺手术的临床资料。结果:2 066例成功完成腔镜手术,29例中转开放手术。手术时间平均(95.0±16.5)min,术中出血量平均(15±2)ml,术后第2天拔除颈部引流管,第3天出院。术后平均随访(50.0±6.3)个月,术后发生颈部出血2例,颈前皮下积液93例,颈前皮肤烫伤5例,术后皮下气肿3例,暂时性喉返神经损伤18例,无永久性喉返神经损伤,术后暂时性甲状旁腺功能减退38例,无永久性甲状旁腺功能减退患者。甲状腺功能亢进患者术后复发4例,甲状腺癌患者术后无复发,无手术相关死亡病例。成功施行腔镜甲状腺手术的2 066例患者对术后美容效果非常满意。结论:胸乳途径腔镜甲状腺手术安全、有效,并发症少,兼具美容效果,尤其适于年轻女性患者,值得在临床推广普及。

Clinical application of endoscopic thyroid surgery via thoracic and breast approach

Objective:To investigate the feasibility,safety and efficacy of endoscopic thyroid surgery via thoracic and breast approach.Methods:A retrospective analysis of 2 095 patients who underwent endoscopic thyroid surgery via thoracic and breast approach from Oct.2006 to Oct.2016 was performed.Results:Endoscopic thyroid surgeries were performed successfully in 2 066 patients while the other 29 patients were converted to open surgery.The mean operation time was (95.0±16.5) min,with the average intraoperative blood loss of (15±2) ml.All the drainage tubes were removed on the 2nd postoperative day and all the patients were discharged on the 3rd postoperative day.The mean follow-up time was (50.0±6.3) months.The postoperative complications included 2 cases of cervical hemorrhage,93 cases of anterior cervical subcutaneous hydrops,5 cases of skin burns,3 cases of subcutaneous emphysema,18 cases of transient recurrent laryngeal nerve injuries,38 cases of transient hypoparathyroidism.No permanent injuries of the recurrent laryngeal nerve or parathyroid were found.There were 4 cases of recurrent hyperthyroidism.None of the thyroid carcinoma patients appeared recurrence or death.The 2 066 patients who successfully underwent endoscopic thyroidectomy were all satisfied with the cosmetic effect.Conclusions:Endoscopic thyroid surgery is safe and effective with few complications and favorable cosmetic effect,and worth clinic promotion,especially for young women.