达芬奇机器人甲状腺手术中气管损伤并发症4例并文献复习  

The complications of tracheal injury in da Vinci robotic thyroidectomy:four case reports and literature review

作　　者：岳涛 庄大勇 周鹏[1] 李小磊 徐婧 朱见 贺青卿[1] YUE Tao;ZHUANG Dayong;ZHOU Peng;LI Xiaolei;XU Jing;ZHU Jian;HE Qingqing(Department of Thyroid and Mammary Surgery,960th Hospital of PLA,Jinan 250031,Shandong,China)

机构地区：[1]中国人民解放军第九六零医院甲状腺乳腺外科,山东济南250031

出　　处：《山东大学耳鼻喉眼学报》2023年第3期46-50,共5页Journal of Otolaryngology and Ophthalmology of Shandong University

基　　金：国家科技部重点研发计划专项课题资助项目(2019YFC0119205);济南市科技创新发展计划项目(202019010)。

摘　　要：目的探讨达芬奇机器人甲状腺手术中气管损伤发生的原因、临床表现、诊断、治疗方法,以期提高对该并发症的认识。方法回顾性分析4例达芬奇机器人甲状腺手术气管损伤患者的临床资料并复习相关文献进行总结。结果达芬奇机器人甲状腺手术气管损伤缺乏特异性症状,临床多以咳嗽和颈胸部皮下气肿为首发症状,可伴有纵隔气肿或气胸,严重者可出现憋喘、呼吸困难等呼吸道阻塞症状。气管损伤进展较快,诊断或治疗不及时常导致严重后果。增强CT气管3D重建或支气管镜检查可明确诊断。结论达芬奇机器人甲状腺手术气管损伤是一种少见并发症,但可能严重威胁患者生命。达芬奇机器人甲状腺手术患者出现皮下气肿和呼吸变化要考虑到气管损伤的可能。Objective To investigate the causes,clinical characteristics,diagnosis and treatment of tracheal injury in da Vinci robotic thyroidectomy and improve the understanding of this complication.Methods Four patients with tracheal injury in da Vinci robotic thyroidectomy were retrospectively analyzed,and relevant literature was reviewed.Results The clinical manifestations of tracheal injury in da Vinci robot thyroidectomy lack specificity;cough and subcutaneous emphysema of neck/chest are usually the initial presentation,which may be accompanied by pneumomediastinum or pneumothorax.Respiratory obstruction symptoms such as wheezing and dyspnea may occur in severe cases.Tracheal injury progresses rapidly,and delayed diagnosis or treatment may lead to serious consequences.Enhanced computed tomography and three-dimensional reconstruction of the trachea or bronchoscopy can confirm the diagnosis.Conclusion Tracheal injury in da Vinci robotic thyroidectomy is a rare but life-threatening complication.Subcutaneous emphysema and respiratory changes in patients who underwent da Vinci robotic thyroidectomy should indicate the possibility of tracheal injury.

关 键 词：达芬奇机器人手术系统 甲状腺切除术 并发症 气管损伤 

分 类 号：R736.1[医药卫生—肿瘤] R768.12[医药卫生—临床医学]