经全乳晕入路腔镜甲状腺手术配合经验总结*

Clinical experience of endoscopic thyroidectomycooperation via areola approach*

摘要:

摘要：目的 探讨经全乳晕入路腔镜下甲状腺手术中的配合技巧。方法 回顾性分析2015年9月－2016年12月该科完成的经全乳晕入路腔镜甲状腺手术110例女患者。其中，甲亢10例，甲状腺癌26例，结节性甲状腺肿60例，甲状腺腺瘤14例。结果 所有患者手术均顺利，未出现术中中转开放情况。手术时间75～240 min，平均（150.5±50.1）min，术中出血量20～180 ml，平均90 ml。术后留置引流管时间2～8 d，平均（3.5±3.4）d，术后住院时间2～14 d，平均（6.8±2.5）d。术后疼痛数字分级评分（NRS）0～4分，平均（1.5±1.2）分。无严重并发症发生，无围手术期死亡患者。与同时期进行的经胸乳入路腔镜甲状腺手术相比较，手术时间、术后疼痛评分和术后并发症的发生率，差异均无统计学意义（P >0.05）。结论 找准正确的筋膜层面、颈部解剖关键点、标志线以及充分的术野暴露是腔镜甲状腺手术成功的关键。

Abstract:

Abstract: Objective To explore the cooperating skills in endoscopic thyroidectomy via the areola approach. Methods 110 cases of patients who underwent endoscopic thyroidectomy were analyzed from September 2015 to December 2016. All the patients were female, including 10 cases of hyperthyroidism, 26 cases of thyroid cancer, 60 cases of nodular goiter, and 14 cases of thyroid adenoma. Results All these patients operation performed smoothly and no intraoperative open-off was observed. The operation time was (150.5 ± 50.1) min (75 ~ 240 min) and the median blood loss was 90 ml (20 ~ 180 ml). Indwelling drainage tube time (3.5 ± 3.4) d (2~8 d) and postoperative hospital stay (6.8 ± 2.5) d (2 ~ 14 d). Postoperative pain was assessed by NRS (1.5 ± 1.2). No serious complications and perioperative death occurred. There was no statistically significant difference in the parameters of operative time, postoperative pain score and postoperative complications compared with thyroidectomy via thoracic breast approach at the same period. Conclusion The correct fascial plane, critical anatomical points, landmark lines, and adequate surgical field exposure is the key to success of laparoscopic thyroidectomy.