局部麻醉下无注气胸前入路内镜甲状腺手术  

Gasless video-assisted thyroidectomy by anterior chest wall with local anesthesia

作　　者：蔡谦[1] 黄晓明[1] 王寿平[2] 郑亿庆[1] 孙伟[1] 陈斌[1] 郭明明[1] 韩萍[1] 梁发雅[1] 

机构地区：[1]中山大学附属第二医院耳鼻咽喉头颈外科,广东广州510120 [2]中山大学附属第二医院麻醉科,广东广州510120

出　　处：《中国内镜杂志》2010年第10期1038-1041,共4页China Journal of Endoscopy

摘　　要：目的探讨无注气胸前入路内镜甲状腺手术在局部麻醉(局麻)下操作的可行性。方法接受无注气胸前入路内镜甲状腺手术的患者共85例,全部患者均采用CT进行术前评价。局麻组27例,年龄(40±7)岁,采用0.5%利多卡因和0.25%罗哌卡因混合液进行双侧颈浅丛神经阻滞麻醉和切口处局部浸润麻醉;全身麻醉(全麻)组58例,年龄(38±10)岁,采用经口气管插管全麻。结果两组中肿块分布情况和术式差异无显著性,全麻组手术室占用时间长于局麻组(122±29)minvs(99±19)min。两组的术中出血量、术后疼痛、术后引流量差异无显著性。全麻组术后有7例(12.1%)出现恶心、呕吐、全身肌肉酸痛等症状。局麻组患者则未出现上述症状。全麻下有2例发生暂时性声带麻痹,经给予营养神经药物处理后1、2个月后恢复正常;局麻下无并发症出现,但两组差异无显著性(精确χ2检验,χ2=0.637,P=1.000)。内镜组和同期传统手术组在美观评分方面比较(47.0vs117.4,Z=-9.752,P=0.000),具有明显美观优势。结论无注气内镜甲状腺手术与传统手术相比,切口的美观性好;局部麻醉可以作为无注气内镜甲状腺手术的麻醉方式之一。【Objective】To investigate on the feasibility of gasless video-assisted thyroidectomy by anterior chest wall under local anesthesia.【Methods】Seventy-six patients accepted gasless video-assisted thyroidectomy by anterior chest wall approach. All patients were evaluated with CT examination before surgery. The local anesthesia group had 27 patients, average age （40±7）; received 0.5% dolicaine and 0.25% ropivacaine mixture to be performed nerve blocking anesthesia on bilateral superficial cervical plexus and local infiltration anesthesia on the cut. The general anesthesia group had 58 patients, average age （38±10）; received oral trachea cannula anesthesia. 【Results】The general anesthesia group took longer time than the local anesthesia group [（122±29） vs （99±19）]; no significant distinction in lump distribution, surgical technic, bleeding volume mid-surgery, postoperative suffering, and postoperative discharge volume. Seven patients （12.1%） in general anesthesia group experienced nausea, vomiting, muscular soreness etc; no such case in local anesthesia group. Two patients in general anesthesia group suffered temporary glottic paralysis and recovered after taking nerve nutritional medicine 1-2 months; no complication in local anesthesia group. Endoscopic group proved obvious cosmetic benefits compared with traditional approach （47.0 vs 117.4, Z=-9.752, P =0.000）. 【Conclusion】Gasless video-assisted thyroidectomy proved a better cosmetic effect. Local anesthesia can be used in gasless video-assisted thyroidectomy.

关 键 词：局部麻醉 内镜甲状腺切除术 无注气 

分 类 号：R581[医药卫生—内分泌] R736.1[医药卫生—内科学]