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1、第14卷第10期腹腔镜外科杂志Vol14,No102009年10月JOURNALOFLAPAROSCOPICSURGERYOc.t2009文章编号:1009-6612(2009)10-0765-03论著非颈部切口内镜甲状腺手术的临床应用*鲁瑶,王文跃,刘海滨,刘军,彭维朝,孟凡强,介建政,周雷,马仁,李启东,李胜利,刘治滨(卫生部中日友好医院,北京,100029)摘要目的:探讨内镜技术用于甲状腺手术的可行性、技术难点及解决方法。方法:回顾分析2006年10月至2008年7月我院为128例患者行内镜甲状腺手术的临床资料。
2、结果:128例中122例内镜手术成功,6例中转手术,其中2例为度甲亢,颈部操作空间不够;4例游离甲状腺肿瘤时引起难以控制的出血。手术时间48~240min,平均85min。术中平均出血15ml。颈部引流管术后3d拔除,术后4d出院。6例皮下积液,2例皮下气肿,2例皮下瘀斑,2例颈部感觉减退,3例吞咽不适,经对症处理很快康复。未损伤喉上神经、喉返神经及甲状旁腺。随访122例6~9个月,无一例复发。患者对术后美容效果非常满意。结论:内镜甲状腺手术出血少,并发症发生率低,具有颈部无瘢痕、美容效果极佳、安全可靠的优点。操作空间的建立,手术视野、甲状腺及肿瘤的良好显露,残留甲状腺体积的正确估计
3、,超声刀的熟练运用,出血的处理及颈前肌群的熟练缝合是手术的关键。关键词甲状腺肿瘤;甲状腺切除术;内窥镜检查;并发症中图分类号:R653文献标识码:ATheclinicalapplicationofendoscopicthyroidsurgerywithoutcervicalincisionLUYao,WANGWen-yue,LIUHai-bin,etal.Dept.oftheSecondGeneralSurgery,China-JapanFriendshipHospital,Beijing100029,ChinaAbstractObjective:Toinvestigat
4、ethefeasibility,keytechniquedifficultiesanditssolutionofendoscopicthyroidectomythroughanteriorchestandbreastapproach.Methods:Aretrospectiveanalysiswasmadeontheclinicaldataof128cases,whoweretreatedwithendoscopicthyroidectomyfromOct.2006toJu.l2008.Andthesafety,indication,contraindication,thekeytec
5、hniquediff-icultiesanditsmanagementoftheoperationwerediscussed.Results:Of128cases,operationsweresuccessfullyperformedin122casesand6caseswereconvertedtoconventionalthyroidectomybecauseof4casesofhemorrhageand2casesoflargethyroidgland.Besides,theoperationtimewas48-240min(mean85min),andtheaverageofi
6、ntraoperativebloodlosswas15m.lPatientsgotridofthedrainagetubesafter3postoperativedaysandweredischargedfromthehospitalafter4postoperativedays.Thepostoperativecomplicationsinclud-edsubcutaneoushydropsin6cases,subcutaneousemphysemain2cases,theneckregionecchymosisin2cases,jugularhypesthesiain2cases,
7、anddiscomfortatswallowingin3cases.Allofthepatientssufferedfromcomplicationsweretreatedbysymptomaticmanage-mentandrecoveredsoon.However,therewerenoothercomplicationssuchaspostoperativebleeding,thehoarse,theinjuryofthesuper-io
