经乳晕入路行腔镜甲状腺切除术的应用价值

目的:探讨行腔镜乳晕入路手术治疗甲状腺疾病的价值。方法:2008年11月至2009年12月为15例患者行经双侧乳晕三孔法腔镜甲状腺手术,通过分离胸前皮下和颈阔肌深面,注入CO2(压力6～8mmHg),建立操作空间。用超声刀切割、分离甲状腺组织和血管;术中保护喉返神经、喉上神经及甲状旁腺。结果:15例手术均获成功,其中甲状腺囊肿切除术1例,甲状腺腺瘤切除术5例,单侧甲状腺部分切除术3例,双侧甲状腺部分切除术3例,甲状腺次全切除术3例。手术时间(110.0±31.3)min,术中出血(70±20.5)ml,术后1例颈部皮肤灼伤,1例胸部少量皮下积液,无中转开放手术。结论:经乳晕径路行腔镜甲状腺手术具有极佳的美容效果,值得临床推广应用。

The application value of endoscopic thyroidectomy via the areola of breast approach

Objective:To study the value of endoscopic thyroidectomy via the areola of breast approach for thyroid diseases.Methods:From Nov.2008 to Dec.2009,endoscopic thyroidectomy via the areola of breast approach was performed in 15 patients.After the thoracic subcutaneous tissue and platysma was separated from deep tissue,the operative space was established by CO2 insufflation with the pressure of 6-8mm Hg.The thyroid tissue and vessels were separated by ultrasound knife.The recurrent laryngeal nerve,superior laryngeal nerve and parathyroid gland were protected.Results:Fifteen operations were successfully performed,among which there were one case of thyroid cyst resection,5 cases of thyroid adenoma resection,3 cases of unilateral thyroid partial resection,3 cases of bilateral thyroid partial resection,3 cases of thyroid subtotal resection.The mean operative time was (110.0±31.3)min,and the mean blood loss was (70±20.5)ml.Burn of neck skin occurred in one case and small amount of subcutaneous chest fluid in another case.No case was converted to open surgery.Conclusions:The endoscopic thyroidectomy via the areola of breast approach has excellent cosmetic results and is worthy to be popularized.