腔镜甲状（旁）腺手术操作空间的细分及其实用意义

Operating space subdivision and its practical significance of laparoscopic thyroidectomy and parathyroidectomy

摘要:

目的 探讨腔镜甲状（旁）腺手术操作空间的建立及划分的实用意义。 方法 120例甲状腺切除术、3例甲状旁腺切除术患者，在建立手术操作空间的过程中，将从胸壁至甲状腺后方的空间划分为1、2、3、4四部分，指出每一个空间的界限、标志及要领。 结果 手术时间105～205 min，平均130 min；术中出血量5～40 mL，平均20 mL；术后创面引流总量30～135 mL，平均75 mL，术后1～4 d拔管，全部病例经术后病理确诊。随访1个月～2年，无明显胸壁创面疼痛、麻木，2例有颈胸皮肤发紧不适感， 无皮肤瘀斑、灼伤、坏死、积液或血肿感染，无抽搐，1例声音嘶哑，2个月后恢复正常。住院时间3～6 d，平均4.5 d。患者对美容效果满意。 结论 操作空间的划分，特别是后三角概念的阐述能让手术医师更深刻而精确地理解建立空间的过程及每一步的操作要点，是一种值得推广应用的方法。

Abstract:

【Objective】 To discuss the way of establishing and dividing operating space and its practical significance of laparoscopic thyroidectomy and parathyroidectomy. 【Methods】 120 cases of thyroidectomy, 3 cases of parathyroidectomy, in the process of establishing the operation space, the space from chest wall to the thyroid rear is divided into four parts named 1st, 2nd, 3th and 4th sub-space, lay stress on space limits, signs and essentials of every step. 【Results】 Operation time was 105~205 min, average 130 min; the amount of bleeding during 5~40 mL, average 20 mL; postoperative wound drainage amount 30~135 mL, average 75 mL, after 1~4 d extubation, all cases were proved by pathological diagnosis after operation, follow-up of 1 months to 2 years, no obvious chest wall wound pain, numbness, 2 cases of cervical and thoracic skin tight discomfort, no skin ecchymosis necrosis or effusion hematoma infection, no convulsions, 1 case of hoarseness, return to normal after 2 months. The hospitalization time was 3~6 d, average 4.5 d. Patients t are satisfactory on the beauty effects. 【Conclusion】 Division operating space, especially the Posterior-triangle concept can make operational doctors more profound and accurate understanding of space and every step of the operation, as is a method worthy of popularization and application.