内镜辅助下经颈径路胸骨后巨大甲状腺肿切除术(附5例报告)  

Endoscopy Assisted Removal of Giant Substernal Goiters through Cervical Approach

作　　者：张潜英[1] 唐正琪[1] 韦军[1] 岳显[1] ZHANG Qianying;TANG Zheng-qi;WEI Jun;YUE Xian(Department of Otorhinolaryngology,Head and Neck Surgery,the Third People's Hospital of Zigong,Zigong 643020,Sichuan,China)

机构地区：[1]四川省自贡市第三人民医院耳鼻咽喉-头颈外科

出　　处：《中国现代手术学杂志》2019年第5期372-376,共5页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨内镜辅助下经颈径路胸骨后巨大甲状腺肿手术切除临床经验。方法回顾性分析2016年5月~2019年2月行内窥镜辅助下经颈入路手术切除的5例巨大胸骨后甲状腺肿患者的临床资料。肿块大小为11cm×6cm×3.5cm^15cm×7cm×5cm。结果5例患者手术均获成功。手术时间平均135(82~198)min,术中出血量平均90(50~100)ml,拔除引流管时间4~6d,住院时间10~14d。无喉返神经损伤、大血管破裂和气胸等并发症。并发暂时性甲状旁腺功能低下者1例,予对症治疗后恢复正常。术后病理示结节性甲状腺肿。所有患者均获随访,时间6~24个月。术后患者无呼吸及吞咽困难,甲状腺肿无复发,甲状腺及甲状旁腺功能均恢复正常。结论经颈部低领切口内窥镜辅助下切除巨大胸骨后甲状腺肿,无需胸骨劈开,具有创伤小、恢复快、并发症少等优点,值得临床进一步探索。Objective To investigate the clinical experience for removal of giant substernal goiters through endoscopic cervical approach.Methods The clinical data of 5 cases with giant substenrnal goiters admitted from May 2016 to February 2019 were analyzed retrospectively.The size of the mass ranged from 11 cm×6 cm×3.5 cm to 15 cm×7 cm×5 cm.All the cases were performed the surgery of removal of giant goiter via cervical approach assisted by endoscope.Results The surgery was accomplished successfully in all 5 cases.The operation time was 82 to 198 minutes with an average of 135 minutes,and the intra-operative blood loss volume was 50 to 100 ml with an average of 90 ml.The drainage tube was pulled out 4 to 6 d after the surgery,and the hospital stays were 10 to 14 days.There was no complications as recurrent laryngeal nerve injury,larger blood vessel rupture and pneumothorax.A transient hypoparathyroidism was found in one case and restored by treatment.The post-operative pathological result revealed nodule goiter.All cases were followed up for 6 to 24 months.All cases recovered the thyroid and parathyroid function without dyspnea,dysphagia and recurrence.Conclusion The endoscopic assisted resection via cervical approach is a safe and effective surgery for giant substernal goiters with advantages of mini-trauma,fast recovery and less complications,whereas it is worthy of further clinical research.

关 键 词：甲状腺肿 胸骨后 巨大 甲状腺手术 内窥镜检查 

分 类 号：R736.1[医药卫生—肿瘤]