腔镜甲状腺切除手术操作要点及喉返神经显露的技巧  

Surgical steps and exposure skills of recurrent laryngeal nerve in total endoscopic thyroidectomy

作　　者：闫巍[1] 张能维[1] 彭吉润[1] 朱斌[1] 宫轲[1] 阿民布和[1] 李凯[1] 张东东[1] 许光中[1] 杜德晓[1] 尹刚[1] Yan Wei Zhang Nengwei Peng Jirun Zhu Bin Gong Ke Amin Buhe Li Kai Zhang Dongdong Xu Guangzhong Du Dexiao Yin Gang(Department of General Surgery, Beifing Shijitan Hospital, Beijing 100038, China)

机构地区：[1]首都医科大学附属北京世纪坛医院普通外科,北京100038

出　　处：《中华普通外科杂志》2016年第12期993-996,共4页Chinese Journal of General Surgery

基　　金：北京市医院管理局重点医学专业扬帆计划资助项目（ZYLX201512）

摘　　要：目的探讨腔镜甲状腺切除手术的操作要点及喉返神经显露的技巧。方法回顾性分析我院2004年10月-2016年5月完成的腔镜甲状腺切除术213例，均采取三孔法经胸乳入路术式，建立通向颈部的隧道和操作空间．游离甲状腺时依照“分、提、撬、拽、断”的要点进行，同时遵循1mm解剖离断和紧贴甲状腺被膜的原则显露喉返神经。结果213例手术全部在腔镜下完成，无中转开放手术；平均手术时间（115±33．6）min，平均出血量（20．7±9．5）ml；单侧甲状腺部分切除者未显露喉返神经47例，其余术式166例均显露RLN。4例出现暂时性声音嘶哑；8例出现口周和手足麻木；5例术后出血，行二次腔镜探查，发现隧道和皮下出血3例，甲状腺创面出血2例，无死亡病例。结论腔镜甲状腺切除术具有突出的颈部美容效果．遵循1mm解剖离断和紧贴甲状腺被膜的原则显露喉返神经，可以提高手术安全性。Objective To investigate the surgical approach and the exposure skills of recurrent laryngeal nerve in total endoscopic thyroidectomy. Methods 213 patients underwent total endoscopic thyroidectomy from Oct 2004 to May 2016. Three hole method and via chest wall and breast pathway was used to set up a chest wall passage to neck and the operating space. We dissect thyroid according to the skills of ＂separate, lift, pry, pull, cut＂. Recurrent laryngeal nerve was exposed on the principle of ＂1 mm dissection and cut＂ and ＂meticulous capsular dissection ＂. Results 213 thyroidectomy was performed by endoscopy. Mean operative time was （115 ± 33.6） min, mean blood loss was （20.7 ± 9. 5 ）ml, RLN was not exposed in 47 cases of unilateral partial lobectomy. RLN was exposed in 166 cases of other surgical procedure. 4 cases suffered from temporary hoarseness, 8 cases had peripheral numbness of mouth and extremity. 5 cases suffered from postoperative bleeding, and were cured by secondary laparoscopic surgery. Operative mortality was nil. Conclusions Total endoscopic thyroidectomy has the prominent neck cosmetic effect. According to principle of 1 mm dissection and meticulous capsular dissection, total endoscopic thyroidectomy can be performed safely.

关 键 词：甲状腺疾病 甲状腺切除术 喉返神经 

分 类 号：R653[医药卫生—外科学]