[1]孙冬林,张丰,杨波,等.胸前壁入路腔镜甲状腺切除术难点与要点[J].中国微创外科杂志,2010,10(10):939-941.
　Sun Donglin,Zhang Feng,Yang Bo,et al.Difficulties and Key Points of Laparoscopic Thyroidectomy via the Chest Wall[J].Chinese Journal of Minimally Invasive Surgery,2010,10(10):939-941.
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胸前壁入路腔镜甲状腺切除术难点与要点()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
10
期数:
2010年10期
页码:
939-941
栏目:
出版日期:
2010-10-01

文章信息/Info

Title:
Difficulties and Key Points of Laparoscopic Thyroidectomy via the Chest Wall
作者:
孙冬林; 张丰; 杨波; 陈学敏; 杨春; 杨岳
江苏省常州市第一人民医院腹腔镜治疗中心，常州213003
Author(s):
Sun Donglin;  Zhang Feng;  Yang Bo;  et al.
Laparoscopic Treatment Center, Changzhou First People’s Hospital, Changzhou 213003, China
关键词:
腹腔镜检查; 甲状腺切除术
Keywords:
Laparoscopy; Thyroidectomy
分类号:
R653
文献标志码:
A
摘要:
目的总结胸前壁入路腔镜甲状腺切除术的难点与要点。方法2008年7月~2010年4月行胸前壁入路腔镜甲状腺切除术168例，于第4肋间正中线偏右以及左右第2肋锁骨中线作切口，游离颈胸部皮瓣后，建立手术空间，超声刀处理甲状腺血管，切除患侧甲状腺大部或全部腺叶。结果成功完成手术166例，2例因术中出血中转开放。手术时间45～210 min，平均89.3 min。术后皮瓣下出血3例，再次腹腔镜下手术止血。饮水呛咳2例，暂时性声音嘶哑7例，皮下气肿3例，皮下瘀斑2例，皮下积液6例，皮瓣感觉异常10例，对症治疗后治愈或自行缓解。168例随访1～19个月，平均10.3月，未复发。结论游离颈胸部皮瓣，处理甲状腺血管，保护喉上神经、喉返神经和甲状旁腺，防止漏切病灶是胸前壁入路腔镜甲状腺切除术的难点和要点。
Abstract:
ObjectiveTo summarize the difficulties and key points of laparoscopic thyroidectomy via the chest wall. MethodsFrom July 2008 to April 2010, we performed laparoscopic thyroidectomy via the chest wall on totally 168 cases. Incisions were made on the right side of the midline in the fourth rib and bilateral midclavicular line in the second rib respectively. The surgical space was built up after the skin flap of the chest and neck was separated, and then thyroid vessels were treated by ultracision harmonic scalpel and subtotal thyroidectomy of the affected side was performed. Results166 cases of laparoscopic thyroidectomy were performed successfully except 2 cases who were converted to open surgery because of massive hemorrhage. The mean operation time was 89.3 minutes in this series (45-210 min). Postoperative complications included postoperative bleeding in 3 cases, which were cured by reoperation, and drinking cough in 2 cases, temporary hoarseness in 7 cases, subcutaneous emphysema in 3 cases, subcutaneous ecchymosis in 2 cases, subcutaneous hydrops in 6 cases and paresthesia in 10 cases, which were cured by symptomatic treatment. Followup for 1-19 months (10.3 months in average) revealed no recurrence. ConclusionSeparation of the skin flap of the chest and neck, treatment of the thyroid vessels, protection of the laryngeal nerve, recurrent laryngeal nerve and parathyroid glands, and avoiding missing lesions are the difficulties and key points of laparoscopic thyroidectomy via the chest wall, which should be treated seriously.

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更新日期/Last Update: 2013-08-12