经乳晕途径单孔腔镜双侧甲状腺手术.docxVIP

经乳晕途径单孔腔镜双侧甲状腺手术 经乳晕途径单孔腔镜双侧甲状腺手术 Transareola?Single-Site?Laparo-Endoscopic?Bilateral?Thyroidectomy 单远洲?朱光辉（共同第一作者）?周联明?唐志强??王时光??张学利（通讯作者） （上海交通大学附属第六人民医院奉贤分院普外科，上海??201400） Yuanzhou?Shan*,?Guanghui?Zhu*,?Lianming?Zhou,?Zhiqiang?Tang,?Shiguang?Wang,?Xueli?Zhang?** ? *These?two?authors?contributed?equally?to?this?work.? ? **Corresponding?author:?Xueli?Zhang,?Ph.D.??M.D., 【摘要】目的??探讨经乳晕途径单孔腔镜行双侧甲状腺手术的可行性、安全性及其优点。方法?本组12例病人通过单侧乳晕切口建立皮下操作空间，置入腔镜和一个操作器械，应用甲状腺缝线悬吊技术显露双侧甲状腺病变组织，用超声刀切离甲状腺。总结临床资料，统计手术时间、术中出血量、术后疼痛评分及术后美容满意度评分等。结果??手术均顺利完成，未中转三孔腔镜手术或开放手术(除外术中冰冻病理为恶性病例)，7例行双侧甲状腺部分切除术，5例行一侧甲状腺次全切除+另一侧甲状腺部分切除术。手术时间135~170?min，平均155min。术中出血量15~40?ml，平均25?ml；术后创面引流的总量为80~135ml，平均110?ml，术后3~4?d拔管。术后24?h疼痛视觉模拟评分为1~5分，平均3.10分。12例病人术后2个月随访，无明显胸壁创面疼痛、麻木，患者对美容效果进行评分（0分为非常不满意，10分为非常满意）为8~10分，平均9.5分。结论??选择适当的病例，经乳晕途径单孔腔镜双侧甲状腺手术安全可行，具有切口隐蔽、皮下分离面积小、美容满意度高等优点。 【关键词】单孔腔镜手术；甲状腺切除术；超声刀 【Key?Words】Laparo-endoscopic?single-site?surgery;?Thyroidectomy?;?Ultrasonic?scalpel ? Laparoendoscopic?single-site?surgery?(LESS),?also?known?as?single-port?surgery,?is?a?novel,?rapidly-advancing?minimally?invasive?procedure.Since?the?first?report?of?LESS?for?tubal?ligation?in?1973[1],?various?single-site?laparo-endoscopic?techniques?or?approaches?have?been?described?in?surgical?discipline[2-4].目前普外科开展较成熟的手术是单孔腹腔镜胆囊切除术[5]、单孔腔镜阑尾切除术[6]等。Many??studies?have?reported?several?advantages?of?single-site?laparo-endoscopic?thyroidectomy?compared?with?open?thyroidectomy,?including?better?cosmetic?results,?a?lower?rate?of?post-operative?complications,?and?better?completion?rate?for?surgery?[7-9].?一般是手术切除单侧甲状腺良性病变.However,?LESS?for?bilateral?thyroidectomy?remains?a?technically?challenging?procedure.?The?two-dimensional?visual?representation?and?use?of?nonflexible?endoscopic?instruments?can?make?it?difficult?to?visualize?the?surgical?field?adequately?and?to?manipulate?instruments. 我院自2011年起已开展经乳晕途径单孔腔镜双侧甲状腺手术12例，取得了良好的效果，现报道如下。 1??临床资料与方法 1.1?一般资料 本组病人12例，女11例，男1例。年龄19~56岁，平均27岁。11例无明显症状（仅表现为甲状腺肿块），1例略感肿块疼痛不适。术