胸骨前徑路腔鏡甲狀腺手術(shù)的臨床應(yīng)用.doc

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1、胸骨前徑路腔鏡甲狀腺手術(shù)的臨床應(yīng)用作者：胡三元，王延磊，王磊，張光永【摘要】　　目的：探討胸骨前徑路腔鏡甲狀腺手術(shù)的臨床應(yīng)用價(jià)值。方法：于胸骨切跡下10cm處建立觀察孔，雙側(cè)鎖骨中線乳頭上方5cm處建立操作孔，行腔鏡甲狀腺手術(shù)治療甲狀腺良性疾病58例，回顧分析其臨床資料。結(jié)果：54例在腔鏡下完成，4例中轉(zhuǎn)常規(guī)手術(shù)。手術(shù)種類(lèi)包括腔鏡甲狀腺瘤切除術(shù)38例、單側(cè)甲狀腺大部切除術(shù)14例，雙側(cè)甲狀腺次全切除術(shù)2例，平均手術(shù)時(shí)間134min（115～230min），出血量26ml（5～80ml），術(shù)后住院時(shí)間4.6d（3～7d

2、）。皮下氣腫1例，皮下淤血4例，頸前區(qū)不適感2例，均于1月內(nèi)消失；所有患者對(duì)美容效果滿(mǎn)意，隨訪8～38個(gè)月，2例結(jié)節(jié)性甲狀腺腫患者術(shù)后復(fù)發(fā)，目前仍繼續(xù)觀察，甲亢患者甲狀腺功能正常。結(jié)論：胸骨前徑路腔鏡甲狀腺手術(shù)在保證美容效果的同時(shí)，進(jìn)一步減小了患者的創(chuàng)傷，具有經(jīng)濟(jì)、安全、有效等優(yōu)點(diǎn)，值得臨床推廣?！娟P(guān)鍵詞】腔鏡手術(shù)；甲狀腺疾??；胸骨前徑路　　Clinicalapplicationofendoscopicthyroidectomybyanteriorchestapproach【Abstract】Ｏbjective:T

3、oexplorethevalueofendoscopicthyroidectomybyanteriorchestapproachinthetreatmentofthyroiddiseases.Methods:Retrospectivelyanalysedtheclinicaldataof58patientswithbenignthyroiddiseasesundergoneendoscopicthyroidectomy,inwhichtheobservationportwasmadeabout10cmbeneath

4、thesternalnotchandtheoperationportsabout5cmabovethenipplesonmidclavicularline.Results:Exceptthat4patientswereconvertedtotraditionaloperations,54patientsreceivedcompleteendoscopicprocedure,includingendoscopicadenomaresection(38cases),unilateralsubtotalthyroidec

5、tomy(14cases),andbilateralsubtotalthyroidectomy(2cases).Themeanoperativetimewas134min(range,115230min);meanbloodlosswas26ml(range,580ml);andmeanpostoperativehospitalizationwas4.6d（range,37d）.1casewascomplicatedwithsubcutaneousemphysema,4caseswithsubcutaneou

6、secchymosis,and2caseswithparaesthesiaofanteriorneckregion,butalldisappearedinlessthan1month.Allthepatientsweresatisfiedwiththecosmeticeffect.Withafollowupof838months,only2patientswithnodulargoiterrecurrentedwhoarestillunderobservation,andthethyroidfunctionof

7、thepatientswithhyperthyroidismarenormal.Conclusions:Endoscopicthyroidectomybyanteriorchestapproachnotonlyhassatisfiedcosmeticeffect,butalsoreducestheoperative5trauma.Combinedwiththeadvantagesofeconomic,safeandeffective,itisworthbeingpromotedclinically.【Keyword

8、s】Endoscopy;Thyroiddiseases;Anteriorchestapproach自從1996年Gagner［1］首次應(yīng)用腔鏡技術(shù)治療甲狀旁腺疾病以來(lái)，腔鏡甲狀腺手術(shù)的開(kāi)展已經(jīng)有10余年的時(shí)間，逐漸被越來(lái)越多的人接受。目前常用的腔鏡甲狀腺手術(shù)徑路很多，各有優(yōu)劣，但總的目標(biāo)是將切口盡量減小、隱蔽以體現(xiàn)其美容效果的同時(shí)，盡量減輕手術(shù)對(duì)機(jī)體的創(chuàng)傷，