甲状腺再次手术中微创理念的应用  

Application of Minimally Invasive Concepts in Re-operative Thyroidectomy

作　　者：周京安[1] 骆成玉 李洋[1] 鲁亦凡 Zhou Jing’an;Luo Chengyu;Li Yang(Department of General Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China)

机构地区：[1]首都医科大学附属北京安贞医院普外科,北京100029

出　　处：《中国微创外科杂志》2022年第5期392-396,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的总结微创理念在甲状腺再次手术中的应用体会。方法回顾性分析2008年1月~2022年1月甲状腺再次手术32例的临床资料,其中复发或持续性分化型甲状腺癌6例,复发性结节性甲状腺肿23例,原发性甲状腺功能亢进(甲亢)术后复发2例,甲状腺腺瘤射频消融术后复发1例。术前精确评估甲状腺残叶、甲状旁腺和神经功能,根据既往手术范围、病理情况,制定再次手术时机和方式,腔镜辅助下联合应用外科能量器械进行精细操作。结果32例均顺利完成手术,手术时间75~150 min,(104.7±16.8)min,出血量40~180 ml,(84.1±32.3)ml。未出现喉返神经、喉上神经和甲状旁腺损伤等并发症。随访时间2个月~14年,中位数69个月,无并发症发生,未见疾病复发。结论微创理念指导下,甲状腺再次手术可以安全施行。Objective To summarize the clinical application of minimally invasive concepts in re-operative thyroidectomy.Methods Clinical data of 32 cases with re-operative thyroidectomy between January 2008 and January 2022 were analyzed retrospectively.Among these patients,there were 6 cases of recurrent or persistent differentiated thyroid cancer,23 cases of recurrent multinodular goiter,2 cases of post-operative recurrence of primary hyperthyroidism,and 1 case of recurrence of thyroid adenoma after radiofrequency ablation.Before re-operation,the thyroid remnant,parathyroid and nerve functions were evaluated.On the basis of previous operation scope and pathological results,the appropriate re-operative timing and surgical approach were formulated.With the assistance of laparoscopy,combined use of surgical energy instruments for meticulous resection was required.Results All the 32 procedures were accomplished successfully.The operative time was 75-150 min(mean,104.7±16.8 min);the intra-operative blood loss was 40-180 ml(mean,84.1±32.3 ml).Neither intra-nor post-operative complications about recurrent laryngeal nerve,superior laryngeal nerve,or parathyroid were observed.The follow-up time ranged from 2 months to 14 years(median,69 months),during which no related complications appeared and there was no recurrence.Conclusion Under the guidance of minimally invasive concepts,re-operative thyroidectomy can be performed safely and effectively.

关 键 词：甲状腺再次手术 结节性甲状腺肿 分化型甲状腺癌 原发性甲状腺功能亢进 射频消融治疗 术后复发 

分 类 号：R73[医药卫生—肿瘤]