不同手术入路在甲状腺手术中应用.docVIP

不同手术入路在甲状腺手术中的应用 　　【摘要】 目的 比较颈前带状肌纵切口与颈白线切口在甲状腺手术中应用的优、缺点。方法 采用颈前带状肌纵切口切开行甲状腺手术43例为治疗组, 颈白线切口行甲状腺手术76例为对照组,均由同一手术组医生施术。分别对2组的肿瘤直径、总手术时间、暴露效果、术中出血量、术后并发症、术后引流量等进行比较。结果 2组患者在性别、年龄、疾病构成以及肿瘤大小方面差异无统计学意义(P0.05)。在相同术式中,治疗组的总手术时间、术中出血量、术后并发症和术后引流量与对照组无明显差异(P0.05),暴露效果优于对照组(P0.05)。结论 采用颈前带状肌纵切口行甲状腺手术的暴露效果优于传统颈白线切口方法,但在处理甲状腺峡部肿物时应采用颈白线切口。 　　【关键词】 手术入路;甲状腺手术;带状肌 　　 　　作者单位:519000 中山大学附属第五医院普外科 　　 　　Application Of Different Operative Approaches in Thyroidectomy 　　 　　LIU Xing-wei,LV Bao-jun, YIN Fang,et al. 　　Department of General Surgery, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China 　　 　　【Abstract】 Objective To compare the advantages and disadvantages of two operative approaches through anterior cervical strap muscles(SM) vs linea alba cervicalis(LAC) in thyroidectomy. Methods 43 patients underwent thyroidectomy through longitudinal incision in SM, 76 patients underwent thyroidectomy through incision in LAC. All these operations were accomplished by the same team of surgeons. The tumor diameter, total operation time, exposure effect,intraoperative bleeding volume, postoperative drainage volume and surgical complications were compared between two groups. Results There were no significant differences of sex, age, disease severity and tumor size between SM and LAC groups(P0.05).Total operation time, intraoperative bleeding volume, postoperative drainage volume and surgical complications in SM group were not significant differenct from LAC group (P0.05). Exposure evaluation scores in SM group were better than that in LAC group (P0.05). Conclusion The exposure effect of thyroidectomy through longitudinal incision in SM is better than that in LAC group. But to tumor of thyroid gland isthmus, thyroidectomy through incision in LAC was better. 　　【Key words】 Operative approach;Thyroidectomy;Strap muscles 　　 　　传统甲状腺手术入路以颈前弧形切口,游离皮瓣后多取颈白线入路,切开后向两侧牵开,如肿物较大,有时还需离断带状肌,存在组织创伤较大,易出血,操作步骤相对增多的缺点。术后容易出现颈部活动时牵扯痛、颈阔肌皮瓣与舌骨下肌群横断缝合处粘连机会增加致颈部活动