经乳房途径行腔镜甲状腺手术的临床应用

目的 :探讨通过乳房途径行腔镜甲状腺手术的可行性及其临床应用价值。方法 :2 0 0 2年 12月至 2 0 0 3年 5月应用经乳房途径腔镜技术治疗甲状腺疾病患者 2 8例。年龄 2 0～ 4 5岁 ,平均 2 8岁。该技术采用经乳房三孔法 ,通过胸前穿刺孔分离胸前皮下和颈阔肌深面 ,并注入CO2 气体 (压力 6～ 8mmHg) ,以建立手术操作空间 ;用超声刀切割、分离甲状腺组织和甲状腺血管 ;术中喉返神经、喉上神经以及甲状旁腺均给予适当保护。结果 :6例患者行腔镜双侧甲状腺手术 ,2例行一侧腺叶切除术 ,17例行一侧腺叶次全切除术 ,3例行甲状腺肿块切除术。 2 8例手术均获成功 ,无一中转 ,无手术并发症。本组患者平均手术时间 (87.1± 2 6 .0 )min ,平均术中出血 (47.9± 19.6 )ml,平均术后住院(3.4± 0 .7)d。颈部引流管于术后 36～ 6 0h拔除。结论 :以低压灌注CO2 气体 ,经乳房途径行腔镜甲状腺手术是安全、可靠的 ,同时具有极佳的美容效果、颈部疤痕。该项技术将会逐渐得到更广泛地应用。

Video-assisted Endoscopic Thyroidectomy by the Breast Approach

Objective: To retrospectively evaluate the feasibility and clinical value of video-assisted endoscopic thyroidectomy by the breast approach. Methods: From December 2002 to May 2003, 28 patients with a mean age of 28 years (range from 20 to 45 years) were selected and given video-assisted endoscopic thyroidectomy by the breast approach. The subcutaneous space in the breast area and the subplatysmal space in the neck were bluntly dissociated through a 10 mm incision between the nipples, and CO2 was insufflated at 6-8 kban to create the operative space. Three trocars were inserted in the mammary regions, and dissection of the thyroid and division of the thyroid vessels and parenchyma were performed endoscopically using an ultrasonically activated scalpel. The recurrent laryngeal nerve, the superior laryngeal nerve, and the parathyroid glands were preserved properly. Results : Among the patients, 3 were mass resections, 17 subtotal lobectomies, 2 total lobectomies, and 6 subtotal lobectomies plus contralateral mass resections. The mean operative time was (87.1 +26.0) min; the mean estimated blood loss was (47.9+ 19.6)ml; and the mean postoperative hospital stay was (3.4±0.7) d. The drainage tubes were pulled out at 36-60 h postoperatively.There were no conversions to open surgery or complications. No scars left in the neck, and the patients were satisfied with the postoperative appearance. Conclusion: Video-assisted endoscopic thyroidectomy using a breast approach and low-pressure subcutaneous CO2 insufflation is a feasible and safe procedure, which results in satisfactory appearance. We believe that video-assisted endoscopic thyroidectomy by such approach will play a role in the future.