经乳晕入路腔镜下甲状腺手术36例报告

目的探讨经乳晕入路腔镜下甲状腺手术的疗效。方法2004年8月～2008年5月甲状腺〈5cm良性结节或腺瘤,经乳沟1.2cm、乳晕0.5cm三孔入路腔镜下使用超声刀游离胸前区、颈前肌群,超声刀处理血管及腺体,完整腺体摘除或腺叶切除。结果35例腔镜下完成手术,1例因术中快速冰冻提示甲状腺癌中转开放手术。手术时间40～120min,平均80min;术中出血量10～60ml,平均40ml。术后6h下床活动,进流质,颈部引流管术后2d拔除。1例术后皮下淤血,2周后消退。术后住院3～5d,平均4d。术后病理：甲状腺瘤28例,结节性甲状腺肿7例,甲状腺癌1例。35例术后随访3～24个月,平均12个月,均无肿瘤复发,乳晕切口无瘢痕形成,美容效果好。结论经乳晕入路腔镜下甲状腺手术近期疗效满意,安全可靠,手术切口隐蔽,颈部无瘢痕,美容效果好。

Experiences on Endoscopic Thyroidectomy via the Breast Areola: Report of 36 Cases

Objective To evaluate the efficacy of endoscopic thyroidectomy via the breast areola. Methods From August 2004 to May 2008, 36 patients with benign thyroid nodules （ 〈 5 cm） received endoscopic thyroidectomy in our department. Three troears were used during the surgery. Small-incisions were made at the points 1.2 cm away from the breast cleavage, and 10 mm and 5 mm away from the left and right breast areolae respectively to place the troears. By using ultrasonic harmonic scalpel, the anterior area of the chest and the muscles of the anterior of the neck were freed, and the thyroid was removed completely. Results Among the cases, 35 patients were treated successfully by endoscopy, the other one case was converted to open surgery because of thyroid cancer shown by intraoperative rapid pathological assessment. The operation time ranged from 40 to 120 minutes with a mean of 80 minutes. During the operation, the patient had 10 to 60 ml blood loss （average, 40 ml）. They were permitted to get of the bed and intake liquid foods in 6 hours. The drainage tube that was indwelt in the neck was removed in 2 days. One patient developed subcutaneous ecehymosis and was then cured spontaneously in 2 weeks. The 36 patients were discharged from the hospital in 3 to 5 days （ mean, 4 days）. Postoperative pathological examination showed thyroid tumor in 28 cases, nodular thyroid hyperplasia in 7, and thyroid cancer in 1. Thirty-five of the patients were followed up for 3 to 24 month with a mean of 12 months, during which no patient had recurrent tumors. None of them developed scars at the breast areolae. Conclusions Endoscopic thyroidectomy via the breast areola is feasible and safe with excellent cosmetic benefits.