-
随着人们健康意识的提高和高分辨率超声的不断普及,以及疾病谱的改变,越来越多的甲状腺癌被发现,甲状腺癌在全球的发病率不断上升,我国的发病趋势也呈倍数增长[1]。到目前为止,在甲状腺癌治疗体系中,外科手术治疗仍然占主导地位。由于其具有低危、预后佳、微小癌和年轻女性占比多等特点和病人对术后生活质量较高的需求,以美容为主要目的的腔镜甲状腺手术应运而生。自韩国CHUNG等[2]在2003年首次开展“无充气腋窝入路完全腔镜下甲状腺手术”以来,近十余年,历经国内外学者不断各种术式探索,手术器械推陈出新,甲状腺的腔镜技术得以快速发展,其安全性和美容效果逐渐被广大临床医生和病人接受。目前手术术式呈现“百花齐放,百家争鸣”状态,多种术式并存[3](胸乳入路、乳晕入路、腋乳入路、腋窝入路、经口入路、耳后入路等),各有优劣,目前尚无统一标准术式。根据建腔介质手术方式可分为CO2充气和免充气两大类,免充气在麻醉安全和节约医疗资源方面的优势不言而喻。本研究团队应用自制改进的免充气建腔器械系统,通过内撑式建腔,在免充气经全乳晕入路腔镜甲状腺手术临床应用20例,现作报道。
免充气腔镜器械在经全乳晕入路腔镜甲状腺手术中的应用
Application value of non-inflating endoscopic instrument in endoscopic thyroid surgery through the whole areola approach
-
摘要:
目的探讨内撑式免充气建腔器械设计和在经全乳晕入路腔镜甲状腺手术临床应用的可行性、安全性。 方法回顾性分析20例甲状腺肿瘤病人的临床资料,使用研究团队研发的建腔器械实施免充气经全乳晕入路腔镜甲状腺手术,并分析相关临床指标。 结果20例病人均顺利完成手术,无中转。术后病理证实甲状腺微小乳头状癌18例,良性甲状腺结节及病变2例;行单侧腺叶切除2例,单侧腺叶+峡部+中央区清16例,双侧侧腺叶+峡部+中央区清2例。手术时间(120.50±40.62)min;中央区淋巴结清扫数目(6.32±3.00)个;术后拔管时间(3.68±2.34)d;术后喉返神经麻痹1例;术后穿刺隧道出血1例,局部加压包扎后停止;术后低钙抽搐1例,3 d后缓解;手术满意度(8.28±1.42)分。 结论内撑式免充气腔镜辅助甲状腺手术临床可行,安全性类似于CO2充气手术,操作简化,同时有降低医疗成本和麻醉风险优势,值得进一步开发和应用。 Abstract:ObjectiveTo investigate the feasibility and safety of the design of the internal support apparatus in endoscopic thyroid surgery via whole areola approach. MethodsThe clinical data of 20 patients with thyroid tumor were retrospectively analyzed.The patients were treated with non-inflatable areola approach endoscopic thyroidectomy using modified cavity construction instrument, and the relevant clinical indicators were analyzed. ResultsTwenty patients were successfully operated, and not be transfered.The results of postoperative pathology showed that 18 cases were minimal papillary carcinoma of thyroid, and 2 cases were benign thyroid nodules.The unilateral lobotomy was performed in 2 cases, the unilateral glandular leaf + isthmus + central area were cleared in 16 cases, and the bilateral lateral glandular leaves + isthmus + central area were cleared in 2 cases.The operation time was (120.50±40.62) min, the number of central lymph nodes dissected was (6.32±3.00), and the postoperative extubation time was (3.68±2.34) days.One case with recurrent laryngeal nerve palsy after operation was found.The postoperative puncture tunnel bleeding in 1 case was stopped after local pressure dressing.The postoperative hypocalcium convulsions in 1 case was relieved 3 days later.The surgical satisfaction was(8.28±1.42) point. ConclusionsThe internal support free air-filling endoscope in assisting thyroid surgery is feasible, similar to that of CO2 and simple to operate.It can reduce medical cost and anesthesia risk, which is worthy of further exploration. -
Key words:
- thyreoidectomy /
- gasless /
- areola approach /
- endoscope technology
-
[1] 董芬, 张彪, 单广良, 等. 中国甲状腺癌的流行现状和影响因素[J]. 中国癌症杂志, 2016, 26(1): 47. [2] SUNG ES, JI YB, SONG CM, et al. Robotic Thyroidectomy: Comparisonof a postauricular facelift approach with a gasless unilateral axillaryapproach[J]. Otolaryngol Head Neck Surg, 2016, 154(6): 997. doi: 10.1177/0194599816636366 [3] WANG Y, SHI RL, SUN TQ, et al. Application options of endoscopic techniques in thyroid surgery[J]. Chin J Gen Surg, 2018, 27(5): 531. [4] BERBER E, BERNET V, FAHEY TJ 3rd, et al. American Thyroid Association Statement on Remote-Access Thyroid Surgery[J]. Thyroid, 2016, 26(3): 331. doi: 10.1089/thy.2015.0407 [5] ZHENG CM, XU JJ, JIANG LH, et al. Endoscopic thyroid lobectomy by a gasless unilateral axillary approach: Ge & Zheng's seven-step method[J]. Chin J Gen Surg, 2019, 28(11): 1336. [6] TAE K, JI YB, SONG CM, et al. Robotic and Endoscopic Thyroid Surgery: Evolution and Advances[J]. Clin Exp Otorhinolaryngol, 2019, 12(1): 1. doi: 10.21053/ceo.2018.00766 [7] CHOI JY, LEE KE, CHUNG KW, et al. Endoscopic thyroidectomy via bilat-eral axillo-breast approach (BABA): review of 512 cases in a singleinstitute[J]. Surg Endosc, 2012, 26(4): 948. doi: 10.1007/s00464-011-1973-x [8] 王康伟, 王永, 金功圣, 等. 腔镜辅助改良Miccoli术式在甲状腺癌颈侧区淋巴结清扫中的应用体会[J]. 腹腔镜外科杂志, 2019, 24(6): 401. [9] 陈昌波, 韩宽怀, 杨建, 等. 完全乳晕入路腔镜甲状腺手术治疗早期分化型甲状腺癌的疗效分析[J/CD]. 中华普外科手术学杂志(电子版), 2019, 13(2): 190. [10] WANG C, FENG Z, LI J, et al. Endoscopic thyroidectomy via areola approach: summary of 1, 250 cases in a single institution[J]. Surg Endosc, 2015, 29(1): 192. doi: 10.1007/s00464-014-3658-8 [11] 王平, 燕海潮. 腔镜下全乳晕入路甲状腺腺叶切除的方法——王氏七步法[J]. 中国普通外科杂志, 2017, 26(5): 541.