乳晕入路内镜下甲状腺切除术操作空间建立的研究-论文.pdf

《乳晕入路内镜下甲状腺切除术操作空间建立的研究-论文.pdf》由会员上传分享，免费在线阅读，更多相关内容在应用文档-天天文库。

1、中国微创外科杂志2014年1月第14卷第1期ChinJMinInvSurg，January2014．Vo1．14．No．1·29·临床论著·乳晕人路内镜下甲状腺切除术操作空问建立的研究檀谊洪杜国能肖玉根陈庞州严国标谭东兴王昆邱万寿”(南方医科大学附属南海医院甲乳外科，佛山528200)【摘要】目的探讨在乳晕人路内镜下甲状腺切除术中建立操作空间的解剖平面。方法2012年6—12月45例行乳晕人路内镜下甲状腺切除术，注水针顶住胸骨柄在胸大肌浅筋膜的深面注射膨胀液，经胸骨上间隙进入颈深筋膜浅层后方建立操作空间。结果45例手术操作成功，分离操作空间的时间平均为6．8min(4～12min)。无神经及甲

2、状旁腺损伤；无一例术后要求药物止痛；无皮肤灼伤、皮下瘀斑、皮下积液、颈部皮肤麻木；2例皮下脂肪液化经换药术后2周内治愈。术后颈部皮瓣水肿表现为胸骨上凹消失(38例)或隆起(7例)，1个月后均恢复正常，43例随访6～12个月，平均7．3月，诉颈部和胸壁皮肤绷紧感分别有24例和3例，在术后3～6个月内消失。结论在乳晕人路内镜下甲状腺切除术中，经胸大肌浅筋膜深面进入颈深筋膜浅层后方的方法建立操作空间简单、快速、暴露好，术后疼痛轻，皮肤并发症少。【关键词】内镜下甲状腺切除术；乳晕入路；胸大肌筋膜中图分类号：R653文献标识：A文章编号：1009～6604(2014)01—0029—03Operatin

3、gSpaceofEndoscopicThyroidectomyviaBreastAreolaApproachTanYihong，DuGuoneng，XiaoYugen，eta1．DepartmentofThyroidandBreastSurgery，NanhaiHospitalAfiliatedtoNanfangMedicalUniversity，Foshan528200，China【Abstract】ObjectiveToinvestigatetheanatomicalplaneoftheoperatingspaceinendoscopicthyroidectomyviabreastareo

4、laapproach．MethodsAtotalof45patientsunderwentendoscopicthyroidectomythroughbreastareolaapproachbetweenJune2012andDecember2012．Expansionliquidwasinjectednearthesternumbeneaththedeeplayerofsuperficialfasciaofpectoralismajorandoperatingspacewasestablishedbehindtheinvestinglayerthroughsuprasternalspace．

5、ResultsAllthe45operationswereperformedsuccessfully．Thetimeforseparatingneckoperatingspacewas6．8min(range，4—12min)．Nonerveandparathyroidinjury，subcutaneoushydrops，ecchymosis，skinburnorneckskinnumbnessoccurred．Twopatientsunderwentfatliquefactionandrecoveredin2weeks．Edemaofneckskinflappresentedasthedis

6、appearanceofsuprasternalnotch(38eases)orelevation(7cases)．Noskinnumbnessoccurred．Duringthefollow-up(range，6—12months；average，7．3months)0f43patients，24and3patientscomplainedoftaut—feelingofcervicalandchestwallskinrespectivelyandthesymptomsdisappeared3to6monthsafteroperation．ConclusionsInendoscopicthy

7、roidectomythroughbreastareolaapproach，establishingoperatingspaceunderneaththeinvestinglayerandbehindthedeeplayerofpectoralfasciaisfastandsimple．Ithastheadvantagesofgoodexposure，lesspostoperativepain，a