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[摘要] 目的:探讨微创甲状腺切除术是否具有微创特点。方法:对51例患者施行微创甲状腺切除术,总结本类手术特点。结果:共51例患者成功施行微创甲状腺切除术,2例中转开放手术。共41例出现并发症:胸颈部皮肤瘀斑、肩背酸痛各6例;高碳酸血症5例;大出血(100～300) ml、皮下气肿各4例;皮下脂肪液化积液,声音低钝、嘶哑,球结膜充血、眼异物感各3例;头痛、头昏、呕吐,皮肤发紧,瘢痕增生各2例;甲状腺危象1例;未出现复发及死亡病例。结论:微创甲状腺节除术仅为美容手术,不具备微创特点。
[关键词] 微创;甲状腺切除术;内镜
[中图分类号] R653 [文献标识码]A [文章编号]1674-4721(2010)06(a)-031-02
Thinking and experience of minimally invasive thyroidectomy
REN Tongliang,WANG Min
(Department of Third Surgery, the Fourth People"s Hospital of Shangqiu City,Henan Province,Shangqiu 476000,China)
[Abstract] Objective:To discuss whether minimally invasive thyroidectomy(MIT) had the characteristics of the minimally invasion or not.Methods: 51 patients were treated with minimally invasive thyroidectomy,and summarized characteristics of this type of surgery.Results:A total of 51 patientswere treated with MIT successfully, 2 cases of open surgery transit. A total of 41 cases of complications occurred: 6 cases of chest and neck skin ecchymosis ,and 6 cases of shoulders ache;5 cases of hypercapnia;4 cases of hemorrhage(100-300) ml and 4 cases of subcutaneous emphysema;3 cases of subcutaneous fat liquefaction,low sound blunt,hoarse,conjunctival hyperemia,eye foreign body sensation respectively,2 cases of headache, dizziness, vomiting, skin tight, and scar formation respectively,1 case of thyroid crisis recurrence,relapse and death were not found in all cases.Conclusion:Minimally invasive thyroidectomy is not minimally invasion but cosmetic surgery.
[Key words] Minimaly invasion;Thyroidectomy;Endoscopy
甲状腺疾病是常见病、多发病,甲状腺切除术是外科的常见手术。内镜甲状腺切除术是近年来发展的一项微创技术。2006年1月～2009年5月,笔者采用不同方法微创甲状腺切除术(minimally invasive thyroidectomy,MIT)治疗51例患者,包括完全内镜下甲状腺切除;内镜辅助下甲状腺切除;非内镜下甲状腺切除3类。现报道如下:
1 资料与方法
1.1 一般资料
本组患者51例,男5例,女46例,年龄13～65岁,中位年龄32.1岁。其中甲状腺腺瘤12例,结节性甲状腺肿27例,原发性甲状腺功能亢进10例,甲状腺癌2例。完全内镜甲状腺手术包括锁骨上(Ⅰ式)、胸前壁和乳晕(Ⅱ式)以及腋窝(Ⅲ式)3种径路,其中Ⅰ式11例,Ⅱ式13例,Ⅲ式11例;内镜辅助甲状腺手术包括胸骨切迹(Ⅳ式)和锁骨下(Ⅴ式)2种径路,其中Ⅳ式4例,Ⅴ式5例;非内镜下甲状腺切除7例(Ⅵ式)。
1.2 术前准备
和常规开放手术一样,术前应全面检查患者,了解患者的心、肺、肝、肾及血液学状况,能否承受长时间的麻醉及手术创伤。甲状腺功能亢进者,术前服用碘剂2周左右,甲亢症状得到基本控制,基础代谢率接近正常,甲状腺缩小变硬及脉率
