腔镜甲状腺次全切除术治疗结节性甲状腺肿72例

目的探讨腔镜下甲状腺叶次全切除术治疗结节性甲状腺肿的方法及临床意义。方法2004年6月至2009年12月，西南医院乳腺中心共完成216例腔镜甲状腺手术中，采用腺叶次全切除术治疗结节性甲状腺肿72例，左侧22例，右侧31例，双侧19例。单发结节41例，多发结节31例，共113个结节，结节直径0．4～6．3cm，平均2．8cm。结果行双侧甲状腺次全切19例，手术时间80～150min，平均97min；单侧次全切53例，手术时间25～12min，平均65min。术中出血5～120ml，平均45ml。行颈丛加局麻68例，耐受良好66例（97％），全麻4例。术后出现暂时性声音嘶哑2例，穿刺道内出血2例。随访3～5年，医患双方对美容效果均非常满意。1例术后半年复查出现单侧结节复发，复发率为1．4％。结论经前胸壁入路或经乳房途径腔镜下甲状腺叶次全切除是治疗结节性甲状腺肿的有效方法，局麻加颈丛在大多数病例安全可靠，游离甲状腺时避免直接抓夹甲状腺组织或肿块，采用钝性推、挡法及超声刀的正确使用可有效减少术中出血，提高安全性。

Endoscopic subtotal thyroidectomy in treatment of nodular goiter: a report of 72 cases

Objective To explore effects of endoscopic subtotal thyroidectomy on nodular goiter and its clinical significance.Methods From Jun.2004 to Dec.2009,72 patients with nodular goiter underwent endoscopic subtotal thyroidectomy in Southwest Hospital.Of the 72 cases,22 cases had left-side nodule,31 cases had right-side nodule and 19 cases had bilateral nodules.Single thyroid nodule occurred in 41 cases and multiple nodules in 31 cases.The total number of nodules was 113.The average nodule size was 2.8 cm(ranging from 0.4 to 6.3 cm).Results Of the 72 cases,19 patients underwent bilateral subtotal thyroidectomy and the mean operative time was 97 min(ranging from 80 to 150 min).53 patients underwent unilateral subtotal thyroidectomy and the mean operative time was 65 min(ranging from 25 to 120 min).The mean intraoperative blood loss was 45 ml (ranging from 5 to 120 ml).Of the 72 cases,68 cases were given cervical plexus block regional anesthesia and among them 66 cases(97%)acquired good anesthesia.Temporary hoarse voice occurred in 2 cases and postoperative bleeding occurred in the subcutaneous tunnel of breast in 2 cases.Patients were followed up from 3 to 5years and the cosmetic result was satisfactory.The postoperative review half year later showed that unilateral nodule recurred in 1 case and the recurrence rate was 1.4%.Conclusions Endoscopic subtotal thyroidectomy through anterior chest wall or breast approach under local anesthesia is a safe and effective treatment in nodular goiter.In the process of dissecting thyroid,blunt maneuver and proper use of ultrasonic knife instead of clamping thyroid nodules directly are recommended in order to reduce intraoperative blood loss and enhance safe practice.