腋窝径路与胸乳径路腔镜甲状腺手术的比较  

Comparative study of the axillary approach and breast approach endoscopic thyroidectomy

作　　者：李良辉[1] 吴国洋[1] 卢毅卓[1] 傅锦波[1] 陈清贵[1] 罗晔哲[1] 

机构地区：[1]厦门大学附属中山医院普外科,福建厦门361004

出　　处：《中国内镜杂志》2013年第10期1036-1040,共5页China Journal of Endoscopy

摘　　要：目的腋窝径路与胸乳径路腔镜甲状腺手术临床效果的对比研究、方法回顾性分析2011年3月～2012年3月102例腋窝径路腔镜甲状腺切除术（腋窝组）和45例胸乳径路甲状腺切除术（胸乳组）的临床资料结果两组在术中出血量、住院时间、声音嘶哑和甲状旁腺损伤方面差异无显著性，腋窝组的手术时间（68.80±22.69）min／较胸乳组（92．22±35.04）min明显缩短，差异有显著性（P〈0.001）；腋窝组的术后引流量（49.56±13.15）mL少于胸乳组（77.78±12.41）mL，差异有显著性（P〈0.001）；术后胸乳组中7例有颈胸不适感，而腋窝组中仅2例有颈胸不适感，差异有显著性（P=0.003）；术后胸乳组中3例出现饮水呛咳，而腋窝组无饮水呛咳的病例发生，差异有显著性（P=0.007）。在气管损伤方面两组差异无显著性，腋窝组有3例，而胸乳组无气管损伤的病例，结论腋窝径路具有更佳的美容效果、更小的颈胸部创伤和更短的手术时间，且处理甲状腺上极病灶也更有优势除了双例甲状腺叶病灶，处理甲状腺峡部的病灶时为减少误伤气管的风险，或以胸孔径路的手术方式为宜。[ Objective] To compare the elinieal effect of the axillary approach and breast approach endoscopic thyroideetomy. ｜Methods] The clinical data of 102 patients treated with axillary approach （axillary group） and 45 patients treated with breast approach （breast group） performed between March 201l and March 2012 was snalyzed retrospeelively. [ Results] There was no significant difference in blood loss, time of stay, hoarseness and parathyroid injury between two groups. Operative time was significantly less in axillary group tban that in breast group [（68.80±22.69） rain vs （92.22±35.04） mini （F 〈0.001）, the volume of drainage was also significantly less in axillary group than that ill breast group [（49.56±13.15） mL vs （77.78±12.41） mL[ （P 〈0.001）. There was significant difference in cervical anti thoracic discomfort between axillat＇y group （2 eases） and breast group （7 cases） （P =0.003）. There was also significant ttifl）rence in drinking cough between axillary group without cases and breast group with 3 eases （P = 0.007）. Despite of no significant difterenee in traeheal injury between two groups, there was higher risk of tracheal injury in axillary group with 3 cases than that in breast group without eases. [Conclusions] Axillary approach has more advantages than breast approach in cosmetic results, cervical/ thoracic injury, operative time and handling of superior lesions. In addition to dealing witb bilateral lesions, breast approach may be more suitable for dealing with lesions of thyroid isthmus to reduce the risk of tracheal injury.

关 键 词：甲状腺腔镜手术 腋窝径路 胸乳径路 

分 类 号：R653[医药卫生—外科学]