腔镜下手术治疗原发性甲状腺功能亢进症52例临床分析

目的对经胸乳途径腔镜手术治疗甲状腺功能亢进（甲亢）的52例患者的临床效果经验体会进行总结。方法自2008年10月～2010年9月,对经内科规范治疗2年以上症状控制不明显的52例甲亢患者实施经胸乳途径行腔镜下甲状腺次全切除术,回顾分析其治疗效果及经验体会。结果腔镜下完成手术47例,中转开放手术5例：其中3例因术中出血难以控制,2例甲状腺体积太大,因手术操作空间不够而中转。手术平均时间115 min（90～250 min）,术中平均出血量35 ml（25～75 ml）,术后2～3 d拔除颈部引流管,术后平均住院5 d（4～6 d）,术后发生一过性声音嘶哑2例,发生胸前皮下淤斑3例,均在术后短期内恢复,无喉上神经、喉返神经及甲状旁腺损伤。46例术后随访12～24个月。术后出现18例甲状腺功能低下,16例为暂时性甲状腺功能低下,3个月后恢复正常,2例3个月后甲状腺功能仍未恢复正常,,需每天口服左旋甲状腺素钠维持甲状腺正常功能,无甲亢症状复发病例,所有患者对术后美容效果非常满意。结论腔镜下手术治疗原发性甲亢是安全、有效、微创美容的外科治疗新方法。

A clinical analysis on 52 cases of primary hyperthyroidism treated by endoscopic operations

【Objective】 To make a summary of the clinical effect and experience on patients in 52 cases of primary hyperthyroidism treated by endoscopic operations through the route of breast.【Methods】 From October,2008 to September,2010,subtotal thyroidectomy with the help of endoscopy and through the route of breast was operated on patients in 52 cases of primary hyperthyroidism whose symptoms were not in obvious control after receiving more than two years of standardized treatment of internal medicine.This article is a retrospective analysis of the treatment effect as well as experiences and comprehension.【Results】 47 operations were finished with the help of endoscopy and 5 cases of open operation were transferred among which 3 cases were transferred due to the difficulty in controlling intraoperative bleeding while 2 cases were due to the insufficient room for performing the operation caused by too big thyroids.The average operation time of duration is 115 minutes(90~250 min),the average amount of intraoperative bleeding is 35 ml(25~75 ml),and the removal of cervical drainage tubes was carried out after 2~3 days on average while the average hospitalizing time after operation was 5 days(4~6 days).18 cases were encountered with hypothyroidism among which 16 cases were temporary and returned to normal after 3 months while 2 cases were still in abnormal thyroid function after 3 months and needed to take oral levothyroxine sodium so as to maintain the normal function of thyroids.No cases had relapsed symptoms of hyperthyroidism and all patients were satisfied with the postoperative cosmetic result.【Conclusion】 Endoscopic Operation on primary hyperthyroidism is a safe and effective new method for surgical treatment with minimally invasive cosmetic result.