三种非颈部径路内镜甲状腺手术的比较  

Three different routes of endoscopic thyroidectomy without scar formation via non-neck opproach

作　　者：胡海[1] 所广军[1] 朱江帆[1] 梁春立[1] 赵中辛[1] 

机构地区：[1]同济大学附属东方医院普外科,上海200120

出　　处：《上海医学》2005年第10期837-839,共3页Shanghai Medical Journal

摘　　要：目的比较3种非颈部径路内镜甲状腺手术方案,以探索颈部无瘢痕手术的合理方案。方法比较双乳间径路(组Ⅰ)、锁骨下径路(组Ⅱ)、单侧乳晕径路(组Ⅲ)3种非颈部径路内镜甲状腺切除术的效果。结果组Ⅰ、组Ⅱ、组Ⅲ的平均手术时间分别为(96.0±27.1)min、(75.0±21.2)min和(121.0±34.2)min(组Ⅰ与组Ⅱ、组Ⅱ与组Ⅲ比较,P值均<0.05;组Ⅰ与组Ⅲ比较,P>0.05),创建皮下隧道所用的平均时间分别为(53.0±17.3)min、(33.0±12.2)min和(67.0±33.0)min(3组两两比较,P值均<0.05),皮下淤斑的发生率分别为3/9例、2/10例和2/7例(3组两两比较,P值均>0.05)。均无术后出血、神经损伤及戳孔并发症。术后住院时间为3～5d。结论非颈部途径无瘢痕甲状腺腺瘤手术是安全可行的。就分离面大小和相应的损伤程度而言,组Ⅰ大于组Ⅱ和组Ⅲ,组Ⅱ与组Ⅲ相当。美容效果依次为组Ⅲ、组Ⅰ、组Ⅱ。操作难度以组Ⅲ最大,与操作者不习惯腔镜位于单侧所得到的影像判断有关。Objective To explore the rational regime and compare three different routes of endoscopic thyroidectomy without scar formation via non-neck opproach. Methods Twenty-six cases with thyroid nodules were divided into three groups according to the position of the incisions for inserting the endoscope. The incisions in 9 cases were made between bilateral nipples （Group Ⅰ ）, 10 on the mid line 3-6 cm below the clavicle （Group Ⅱ ） and 7 in the peri-areola on the ipsilateral side of the thyroid nodules （Group Ⅲ ）. Results Endoscopic thyroidectomy was successfully performed in all 26 patients without obvious complications. The average operation duration in Group Ⅰ was （96.0±27.1） minutes, in Group Ⅱ （75.0±21.2） minutes and Group Ⅲ （121.0±34.2） minutes. The average duration for creating subcutaneous tunnel was （53.0± 17.3） minutes in group Ⅰ , （33. 0±12.15） minutes in group Ⅱ and （67.0±3.0） minutes in group Ⅲ. The ecchymosis caused by subcutaneous oozing was observed in 3/9 patients of group Ⅰ , 2/10 of group Ⅱ and 2/7 of group Ⅲ. Conclusions All the routes we design for the operative field are safe and feasible for endoscopic thyroidectomy. The operation duration required and the degree of injury are related to the dissecting area for creating subcutaneous tunnel. The peri-areola route will be of choice in terms of better cosmetic purpose. （Shanghai Med J,2005,28：837-839）

关 键 词：甲状腺切除 内镜 

分 类 号：R653[医药卫生—外科学]