经胸乳入路腔镜甲状腺手术92例体会  

Endoscopic thyroidectomy via the chest and breast approach:a report of 92 cases

作　　者：蒋超[1] 张云[1] 张楷[1] 詹峰[1] 

机构地区：[1]江苏大学附属宜兴医院,江苏宜兴214200

出　　处：《腹腔镜外科杂志》2016年第4期271-273,共3页Journal of Laparoscopic Surgery

摘　　要：目的：探讨总结经胸乳入路腔镜甲状腺手术的方法、术中要点及临床应用。方法：回顾分析2012年5月至2015年5月92例甲状腺肿块患者的临床资料,观察手术时间、术中出血量、术后24 h引流量、术后24 h疼痛、术后住院时间、住院费用、并发症及美容满意度等指标。结果：92例手术均顺利完成,无一例中转开放。手术时间单侧平均（76.93±18.09）min,双侧平均（92.81±25.38）min;术中出血量单侧平均（21.00±8.70）ml,双侧平均（25.39±9.17）ml;术后24 h引流量单侧平均（80.11±22.51）ml,双侧平均（118.00±42.02）ml;术后单侧平均住院（5.12±0.62）d,双侧平均（5.35±0.38）d;住院费用单侧平均（12 102.63±436.46）元,双侧平均（12 945.78±532.11）元。术后24 h疼痛调查：不痛49例、可忍受38例、难以忍受5例;术后疤痕满意度随访调查：非常不满意1例、不满意4例、满意22例、较为满意20例、非常满意45例。术后1例出现颈前部皮下积血致呼吸困难,1例出现颈前胸壁术区皮肤红肿,2例短暂声音嘶哑,1例术后低钙性四肢麻木;均无永久性喉返神经损伤及甲状旁腺损伤等其他并发症发生。术后随访1个月~1年,中位随访时间6个月,未见复发。结论：经胸乳入路腔镜甲状腺手术近期疗效满意,安全可靠,美容效果好,有望逐步成为甲状腺良性疾病外科治疗的主流术式。Objective：To investigate and summarize the operation technique,key points and clinical application of endoscopic thyroidectomy via the chest and breast.Methods：From May 2012 to May 2015,endoscopic thyroidectomy via the chest and breast approach was performed in 92 patients in the Affiliated Yixing Hospital of Jiangsu University.The clinical data such as operative time,intraoperative blood loss,drainage volume in 24 h after operation,pain in 24 h postoperatively,postoperative hospital stay,hospital cost,complication and cosmetic results were collected and analyzed retrospectively.Results：All the 92 patients were treated successfully by endoscopy and no one was converted to open surgery.The mean operation time was [Unilateral：（ 76.93 ± 18.09） min,Bilateral：（ 92.81 ± 25.38） min].The average intraoperative blood loss was [Unilateral：（ 21.00 ± 8.70） ml,Bilateral：（ 25.39 ± 9.17） ml].The postoperative drainage volume in 24 h after operation [Unilateral：（ 80.11 ± 22.51） ml,Bilateral：（ 118.00 ± 42.02） ml].The mean postoperative hospitalization stay was [Unilateral：（ 5.12 ± 0.62） d,Bilateral：（ 5.35 ± 0.38） d].The hospital cost was [Unilateral：（ 12 102.63 ± 436.46） yuan,Bilateral：（ 12 945.78 ± 532.11） yuan].The pain in 24 h postoperatively results were（ no pain,endurable pain,intolerable were 49,38,5 cases respectively）.The cosmetic results were（ very dissatisfied,not satisfied,satisfied,comparatively satisfied,and very satisfied were 1,4,22,20,45 cases respectively）.One case suffered from dyspnea due to bleeding and underwent laparoscopic exploration again.One case had chest wall area skin redness,swelling.Two cases suffered transient hoarseness.One case had trembling hand due to low calcium level.No permanent recurrent laryngeal nerve injury,parathyroid injury or other complications occurred.No recurrence happened during a period of 1 month to 1 year（ median follow-up：6 months）.Conclusions：Endoscopic thyroidectomy via the chest and

关 键 词：甲状腺切除术 内窥镜检查 胸乳入路 

分 类 号：R736.1[医药卫生—肿瘤]