胸骨前径路腔镜甲状腺手术的临床应用.doc

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1、胸骨前径路腔镜甲状腺手术的临床应用作者：胡三元，王延磊，王磊，张光永【摘要】　　目的：探讨胸骨前径路腔镜甲状腺手术的临床应用价值。方法：于胸骨切迹下10cm处建立观察孔，双侧锁骨中线乳头上方5cm处建立操作孔，行腔镜甲状腺手术治疗甲状腺良性疾病58例，回顾分析其临床资料。结果：54例在腔镜下完成，4例中转常规手术。手术种类包括腔镜甲状腺瘤切除术38例、单侧甲状腺大部切除术14例，双侧甲状腺次全切除术2例，平均手术时间134min（115～230min），出血量26ml（5～80ml），术后住院时间4.6d（3～7d

2、）。皮下气肿1例，皮下淤血4例，颈前区不适感2例，均于1月内消失；所有患者对美容效果满意，随访8～38个月，2例结节性甲状腺肿患者术后复发，目前仍继续观察，甲亢患者甲状腺功能正常。结论：胸骨前径路腔镜甲状腺手术在保证美容效果的同时，进一步减小了患者的创伤，具有经济、安全、有效等优点，值得临床推广。【关键词】腔镜手术；甲状腺疾病；胸骨前径路　　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自从1996年Gagner［1］首次应用腔镜技术治疗甲状旁腺疾病以来，腔镜甲状腺手术的开展已经有10余年的时间，逐渐被越来越多的人接受。目前常用的腔镜甲状腺手术径路很多，各有优劣，但总的目标是将切口尽量减小、隐蔽以体现其美容效果的同时，尽量减轻手术对机体的创伤，