康杰1(胸乳途径甲状腺内镜手术).doc

·大会交流· 胸乳途径甲状腺内镜手术 康杰 樊友本 伍波 郭伯敏 闫钧 张频 郑起200233 上海，上海交通大学附属第六人民医院普外科 【摘要】目的 报道经胸乳入路腔镜甲状腺手术的临床应用价值。方法 总结28例经胸乳途径腔镜甲状腺手术的临床资料。结果 肿块直径1.7cm～4.5cm，平均2.9cm；手术时间平均128（95～165）min；病理结果：甲状腺腺瘤15例，结节性甲状腺肿12例，均行甲状腺腺叶全切和次全切除术，甲状腺乳头状癌1例中转。1例术后暂时性声音嘶哑，无术中术后大出血和术后抽搐。18例胸前区轻微胀痛不适持续7d～19d，均无需服用止痛药，美容满意率90%。结论 胸乳途径甲状腺内镜手术疗效可靠、创伤不大、美容效果极佳。 【关键词】腔镜；甲状腺切除术；胸乳途径 【中图法分类号】R653 【文献标识码】B Endoscopic thyroidectomy via breast areola approach KANG Jie,FAN You-ben,WU Bo,GUO Bo-min,YAN Jun,ZHANG Pin,ZHENG Qi. Department of general surgery, Shanghai Jiaotong University Affiliated Sixth people’s Hospital, shanghai 200233, China 【Abstract】Objective To investigate the curative effect of endoscopic thyroidectomy via breast areola approach. Methods The clinical data of 28 cases of endoscopic thyroidectomy via breast areola approach were retrospectively summarized. Results The mean diameter of the tumor was 2.9(1.7～4.2)cm. The mean operative time was 128(95～165) min. Pathologic data: adenoma in 15 cases, nodular goitar in 12 cases, papillary carcinoma indicated intraoperatively by frozen section in 1 case. One case occurred temporary hoarseness. No intraoperative and postoperative hemorrhea and convulsion after operation. Minor pain and discomfort in anterior chest continued for 7～19d in 18 cases, all without taking painkillers, satisfaction rate of beauty was 90 percent. Conclusion Endoscopic thyroidectomy via breast areola approach is safe and feasible for patients with thyroid diseases , and has excellent cosmetic results. 【KeyWords】Endoscope；Thyroidectomy；Breast areola approach 甲状腺疾病好发于年轻女性，传统甲状腺手术可在颈部留下6～10瘢痕，影响美观，甚至局部严重不适。1997年Huscher等[1]报道首例腔镜甲状腺切除术，具有切口隐蔽、颈部美容的效果。腔镜手术是切口微小，并转移到颈部以外的胸部和乳晕，颈部无瘢痕的甲状腺切除术。 1 临床资料 1.1一般资料 28例系我院2008年1～8月收治的患者，女性26例，男性2例；年龄23～38岁，平均27.4岁；体检和B超检查均为一侧单发结节，边界清楚，肿块直径1.7㎝～4.5㎝，平均2.9㎝，颈部淋巴结阴性。术前甲状腺功能测定和常规检查正常。无甲状腺手术史及疤痕体质。 1.2手术方法 取仰卧位，肩后垫枕，头轻度后仰，两腿分开类似于膀胱截石位。行全身麻醉和气管插管。术者站在两腿之间，扶镜助手站在一侧。于双侧乳晕上缘开0.5㎝～1㎝切口，在乳头水平连线中点旁1纵行切开1切口，达胸部深筋膜。用气腹针沿预先划好的皮下隧道线将膨胀液（肾上腺素1mg加500ml生理盐