胸乳入路腔镜甲状腺切除术51例

目的：探讨胸乳入路腔镜下甲状腺手术的临床应用价值。方法我科自2010年3月至2013年4月完成胸乳入路腔镜甲状腺切除术51例，其中甲状腺腺瘤22例，结节性甲状腺肿29例。结果51例手术均取得成功，其中一侧腺叶部分切除术22例，一侧次全切除术23例，一侧次全切除另侧部分切除术4例，双侧次全切2例。无喉返神经、喉上神经损伤、无甲状旁腺损伤。手术时间60~120 min，出血量5~20 ml。颈部皮肤瘀斑8例，未予特殊处理，出院后两周自行吸收。皮下气肿15例，经过挤压、负压吸引痊愈。切口渗出较多、脂肪液化2例，经过局部引流、压迫在一周内痊愈。手术区域巨大血肿1例，术后4 h 再次局部麻醉下从胸部切口吸引清除，加置1根引流管，压迫止血后痊愈。51例随访6~24个月，无复发，所有患者对美体效果满意。结论胸乳入路腔镜下甲状腺切除术是治疗良性甲状腺疾病的一种很好的选择，颈部无痕的美容效果受到部分患者的欢迎，值得临床推广；但由于颈部解剖复杂，血管、神经变异较多，内镜下操作空间小，操作具有相当的难度，因此在开展初期应该选择合适的病例，循序渐进，逐步扩大手术适应证。

Endoscopic thyroidectomy via chest-breast approach with 51 cases

Objective To study the clinical value of endoscopic thyroidectomy via chest-breast approach. Methods From Mar. 2010 to Apr. 2013, endoscopic thyroidectomy was performed on 51 patients via chest-breast approach. Among the patients,22 cases had thyroid adenoma,29 cases had Nodular goiter. Results All the patients were succeeded through endoscopic thyroidectomy,22 cases were unilateral partial thyroidectomy,23 cases were unilateral subtotal thyroidectomy surgery,1 case was unilateral partial and unilateral subtotal thyroidectomy surgery,2 cases were double subtotal thyroidectomy surgery. No injury of the recurrent laryngeal nerve,superior laryngeal nerve and parathyroid. The operations time was 60-120 min and the amount of bleeding was 5-20 ml. Eight had neck skin ecchymosis,self-absorbed two weeks after discharge with no special treatment. Fifteen was subcutaneous emphysema,cured with squeezing and vacuum suction. Two cases were fat liquefaction,cured in one week with drainage and compression. One had huge hematoma,cured with timely drainage,oppression and hemostasis. Fifty-one patients were followed up for 6 to 24 months,none of them had recurrence,and all of them were satisfied. Conclusion Endoscopic thyroidectomy via chest-breast approach is a good choice for the treatment of benign thyroid diseases,and seamless neck cosmetic results is welcomed by some patients. However,neck anatomy is complex and blood vessels,nerves are changeable. Endoscopic operating has only a small space,and operates with considerable difficulty. Therefore,to carry out the early cases should choose the right,step by step,gradually expanding surgical indications.