47例腋乳入路腔镜甲状腺手术效果观察  

Curative effect of endoscopic thyroidectomy via axillary-breast approach in 47 cases

作　　者：欧阳军[1] 李政[1] 陈向恒[1] 

机构地区：[1]南华大学附一医院肿瘤外科,湖南衡阳421001

出　　处：《实用医院临床杂志》2014年第1期123-125,共3页Practical Journal of Clinical Medicine

摘　　要：目的探讨经腋乳入路腔镜甲状腺手术的方法、技巧及美学效果。方法对47例甲状腺肿块患者采用经右侧腋窝及双侧乳晕入路（腋乳途径），通过分离胸颈前皮下，注入CO，（压力6—8mmHg）建立手术操作空间。超声刀切割、分离甲状腺组织和甲状腺血管；术中保护喉返神经、喉上神经以及甲状旁腺。结果47例手术均顺利完成，手术时间72—130rain，出血量5—56m1，无中转开放手术者，无胸壁血肿者。暂时性声嘶2例，暂时性低钙3例，1月后均恢复。平均带管时间2．2天，平均住院时间5．3天。术后随访3～16个月，无复发病例。患者颈、胸部皮肤颜色无明显改变，腋窝及双侧乳晕切口疤痕均不明显，患者对美学效果满意。结论经腋乳入路腔镜甲状腺手术是安全可行的，且具有良好的美学效果。Objective To explore the operative methods,techniques and cosmetic results of endoscopic thyroidectomy via axil- lary-breast approach. Methods Endoscopic thyroidectomy was performed via axillary-breast approach in 47 patients with thyroid mass. The subcutaneous space in the breast area were bluntly dissected ,and CO2was insufflated at 6-8 mmHg to create the operative space. The dissection of the thyroid and division of the thyroid vessels and parenchyma were performed endoscopically by using an ultrasonical- ly activated scalpel. The recurrent laryngeal nerve, the superior laryngeal nerve, and the parathyroid glands were preserved properly dur- ing the operation. Results The surgery was successfully accomplished in all the 47 cases. The operation time ranged 72-130 rain. The intraoperative blood loss ranged 5-56 mh There was no conversion to open surgery. No chest wall hematoma occurred. Transient hoarse- ness was developed in 2 cases and transient hypoealcemia in 3 cases. They were recovered within 1 month. The average time of drainage was 2. 2 days after operation. The average postoperative hospital stay was 5.3 days. The patients were followed up for 3-.16 months. No recurrence was observed during the follow-up period. The wounds were healed well in all the patients. The colors of cervical skin and chest skin had no obvious change, and the scars in the axillary and bilateral areola incisions were inconspicuous. All patients were satis- fied with the cosmetic results. Conclusion Endoscopic thyroidectomy via axillary-breast approach is a safe and feasible procedure with satisfactory cosmetic results.

关 键 词：甲状腺疾病 腔镜 微创手术 

分 类 号：R653[医药卫生—外科学]