微创医学

目的探讨经腋入路单孔腔镜甲状腺手术的可行性、安全性及美容效果。方法行经腋入路单孔腔镜甲状腺手术53例,甲状腺单侧占位,占位直径15～50 mm,平均直径37.4 mm,沿皮纹于腋窝顶部做25 mm切口,置入自制操作通道,放置1个10 mm观察孔和2个5 mm操作孔,使用超声刀切除单侧大部分或全部甲状腺。结果 51例顺利完成经腋入路单孔腔镜甲状腺手术,2例中转开放手术,顺利完成单孔手术时间83～175 min,平均112 min,术中出血量5～50 mL,平均10.2 mL,术后住院时间平均3.1 d,术后病理24例为结节性甲状腺肿,24例为甲状腺腺瘤,5例为甲状腺癌,其中4例术后追加根治手术,1例予内分泌治疗。术后2例出现局部积液,无气管、喉返神经、甲状旁腺损伤等并发症。术后经2～20个月随访,美容评分为8.6分,未见肿瘤复发。结论经腋窝入路单孔腹腔镜甲状腺手术,无需特殊器械,手术安全可行,但需选择恰当的病例。

Objective To evaluate the safety，feasibility，and cosmetology of single-incision endoscopic thyroidectomy ( SIET) with routine equipment by the axillary approach． Methods Trans-axillary SIET with routine equipment was performed in 53 cases with unilateral thyroid nodule( mean size 37． 4 mm in diameter， ranged from 15 to 50 mm) ． One 25mm skin incision in the middle of axillary fossa were made along the cleavage lines，self-made single-Incision operation channel was placed，one 10-mm two 5-mm trocars were inserted through the single-incision t channels，and most or total thyroid were removed by harmonic scalpel． Results 51 cases were successful underwent SIET，with only 2 cases converted to open procedures． Operating time of SIEP was about 83 to 175 min with a mean of 112 min，the mean blood loss were 10． 2 ml( 5 － 50 ml) ， and the patients were discharged averagely in 3． 1 days． The postoperative pathological results included 24 cases of thyroid adenoma，24 cases of nodular goiter，5 cases of papillary thyroid carcinoma ( 4 were performed additionally with radical thyroidectomy，and one endocrinological treatment ) ． 2 subcutaneous hydrops were reported，but without complication like injury in airtube，aryngeal nerve，or parathyroid gland． All patients were followed up for 2 months to 20 months，and cosmetic score was 8． 6． No recurrence occurred． Conclusions Based on appropriated selection of patients，trans-axillary SIET without any special instrument is safe and feasible with good cosmetic results．