腔镜甲状腺切除术并发症的原因与防治

目的探讨腔镜甲状腺切除术并发症的原因,总结防治经验。方法 2002年7月～2009年12月共完成372例经胸入路腔镜甲状腺切除术,其中24例发生并发症,发生率6.5%。术式包括单侧腺叶切除+峡部切除1例,患侧腺叶全切+峡部切除+对侧腺叶次全切除+气管前、气管旁淋巴结切除2例,患侧腺叶近全切除+峡部切除+对侧腺叶切除4例,17例行双侧腺叶次全切除术。结果并发症包括2例Ⅰ度皮肤灼伤,1例注射肾上腺素盐水3 min后胸部皮肤暂时性缺血,3例术后第1天左侧乳腺处trocar通道出血,4例暂时性声嘶,2例暂时性呛咳,3例皮下积液,7例胸部皮下组织淤血,经对症处理,22例均痊愈;2例残留甲状腺结节,患者无不适,术后B超分别随访6年1个月、5年8个月,结节大小无改变。结论腔镜甲状腺切除术安全可行,手术操作不当可能出现并发症,应不断提高腔镜技术和超声刀的使用,熟悉镜下甲状腺解剖,小心操作。

Causes and Prevention of Complications of Endoscopic Thyroidectomy

Objective To explore the causes and preventive methods of complications of endoscopic thyroidectomy.Methods Endoscopic thyroidectomy via the breast approach was performed on 372 cases from July 2002 to December 2009.The procedures carried out included unilateral lobectomy and isthmectomy in 1 case,unilateral lobectomy,isthmectomy and contralateral subtotal lobectomy with pre-and para-tracheal lymph nodes dissection in 2 cases,unilateral neartotal lobectomy,isthmectomy and contralateral subtotal lobectomy in 4 cases,and bilateral subtotal lobectomy in 17 cases.Among the cases,surgical complications were found in 24 patients with an incidence rate of 6.5%. Results Complications occurred in totally 22 of the patients,including 2 cases of skin burn,1 case of transient chest skin ischemia after injecting epinephrine-saline,3 cases of bleeding in the left mammary trocar road on the first day postoperation,4 cases of transient hoarseness,2 cases of transient choke,3 cases of subcutaneous fluid collection,and 7 cases of chest subcutaneous bruising.All the complications were cured by conservative therapies.Two patients showed residual asymptomatic thyroid nodules;they were followed up with B-ultrasonography for 73 and 68 months respectively after being discharged;during the period,no change of the nodular size was detected.Conclusions Endoscopic thyroidectomy via the breast approach is feasible and safe.Improper operative procedure may result in complications,and thus it is necessary to improve endoscopic techniques and operative skills in ultrasonic scalpel.Operators should also be familiar with thyroid dissection under endoscope and be careful during the operation.