免充气低创前胸入路腔镜甲状腺切除术.docVIP

免充气低创前胸入路腔镜甲状腺切除术【摘要】 目的 探讨颈前皮瓣细线悬吊(免充CO2 气体)建立皮下手术空间,经缩短的胸乳入路行腔镜甲状腺手术的临床价值。 方法 对41例甲状腺疾病,其中结节性甲状腺肿29例、甲状腺瘤11例，原发性甲状腺功能亢进1例, 取缩短的胸乳入路 (前胸切口到胸骨上窝的皮下隧道的长度恰好是通用戳卡的长度)，并缩小颈前区分离的范围，利用30 ProleneTM缝线悬吊颈前区皮瓣形成手术空间完成甲状腺次全切除手术。 结果 41例手术均成功完成,无中转开放手术。手术时间50～150 min,平均(755±16) min,术中出血5 ～30 ml,平均(10±4)ml。术后恢复顺利。41例随访3～24个月, 平均(122±36)个月, 无并发症发生, 美容效果较好。 结论 免充气低创前胸入路腔镜甲状腺切除术是一种安全可行的手术方法。与通常的腔镜甲状腺手术比较，该术式避免术中充注CO2 气体所引起的相关并发症,且手术创伤小。虽然其手术空间较充气法稍小,但手术的进行基本不受影响。 【关键词】 甲状腺疾病；免充气; 内镜; 胸乳入路; 甲状腺切除术 Endoscopic thyroidectomy via shorten breast approach using thin suture and gasless anterior neck skin lifting method ZHANG Hao，ZHANG Yunsheng，JIN Xiongwei, et al.Department of General Surgery, Dongguan Kanghua Hospital, Dongguan 523080,China 【Abstract】 Objective To study the benefits and drawbacks of endoscopic thyroidectomy via shorten breast approach by using gasless anterior neck skin lifting with method Methods A total of 41 patients with thyroid diseases were enrolled in this study, including 29 cases of nodular goiter, 11 cases of thyroid adenoma and 1 cases of primary hyperthyroidism All the cases underwent endoscopic subtotal thyroidectomy through shorten breast approach (Usual trucar can exactly reach the suprasternal fossae through subcutaneous tunnel) and diminished subplatysmal dissections, while the operational space was established by using some ProleneTM suture to mechanically suspend and retract the anterior neck skin Results The endoscopic subtotal thyroidectomy was completed successfully in all of the cases without conversion to open surgery The metion an operation time was (755±16) minutes (ranging from 50 to 150 minutes) Intraoperative blood loss was 5 ～30 ml,mean (10±4)ml Post operational recovery was satisfying in all the patients, The patients were followed up for 3～24 monthes, mean(122±36) monthes after the operation during which no complications occurred and cosmetic outcome was advantage Conclusion Endoscopic thyroidectomy via shorten breast