经胸乳入路腔镜甲状腺手术180例体会

目的:总结经胸乳入路腔镜甲状腺手术的技巧及并发症的预防经验。方法:回顾分析2011年6月至2013年8月为180例患者经胸乳入路行腔镜甲状腺切除术的手术过程及并发症发生情况,总结手术并发症的危险因素及预防措施。结果:179例手术获得成功,1例因术中出血中转开放手术。单发甲状腺腺瘤43例,结节性甲状腺肿116例,原发性甲状腺机能亢进2例,甲状腺癌19例。手术时间平均(105±10)min;术中出血量10~50 ml,平均(15±9.5)ml;术后发生皮下淤血7例、颈前积液12例、颈部及胸前皮肤发紧不适5例、一过性低钙18例、喉上神经损伤9例、暂时性喉返神经损伤13例。结论:掌握手术适应证,具备熟练的腔镜操作技巧,严格遵循腔镜手术操作规范,熟悉甲状腺的解剖结构,是手术成功及减少并发症的关键。

Analysis of endoscopic thyroidectomy via breast approach in 180 cases

Objective：To investigate the surgical technique and the methods of preventing complications of endoscopic thyroidectomy via breast approach. Methods：Retrospective analysis was made on the operation process and complications of 180 cases of endoscopic thyroidectomy via breast approach from Jun. 2011 to Aug. 2013. And the risk factors and the preventive measures of operation complications were summed up. Results：One patient was converted to open surgery because of intraoperative hemorrhage,the other 179 cases were successful. There were 43 cases of solitary thyroid adenoma,116 cases of nodular goiter,2 cases of primary hyperthyroidism,and 19 cases of thyroid carcinoma. The average operation time was（105 ± 10） min. Intraoperative blood loss was about 10-50 ml,with an average of（15 ± 9. 5） ml. Postoperative complications included 7 cases of subcutaneous congestion,anterior cervical effusion in 12 cases,neck and chest skin tight discomfort in 5 cases,transient hypocalcemia in 18 cases,9 cases of superior laryngeal nerve injury and transient recurrent laryngeal nerve injury in 13 cases. Conclusions：Knowing well about the operative indications,mastering laparoscopic operation skills,following the operating rules of endoscopic operation,acquaintance about the anatomical structure of the thyroid are the keys to the success of operation and decrease of the complications.