经全乳晕入路腔镜甲状腺手术配合经验总结
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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。
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 September2015 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 signi?cant 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 ?eld exposure is the key to success of laparoscopic thyroidectomy.
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 September2015 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 signi?cant 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 ?eld exposure is the key to success of laparoscopic thyroidectomy.
引文
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[3]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):541-546.[3]WANG P,YAN H C.Endoscopic thyroid lobectomy via bilateral areolar approach-Wang’s seven-step method[J].Chinese Journal of General Surgery,2017,26(5):541-546.Chinese
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[6]李三荣,刘仁胜,张燕,等.腔镜甲状腺手术中喉返神经的显露与保护[J].中国微创外科杂志,2015,15(9):846-848.[6]LI S R,LIU R S,ZHANG Y,et al.Exposure and protection of recurrent laryngeal nerve in endoscopic thyroidectomy[J].Chinese Journal of Minimally Invasive Surgery,2015,15(9):846-848.Chinese
[7]贾高磊,田志龙,高新宝,等.腔镜甲状腺腺叶切除术喉返神经的保护体会[J].中国微创外科杂志,2016,16(11):1006-1008.[7]JIA G L,TIAN Z L,GAO X B,et al.Experience of protecting recurrent laryngeal nerve in endoscopic thyroidectomy[J].Chinese Journal of Minimally Invasive Surgery,2016,16(11):1006-1008.Chinese
[8]王波,徐旭东,刘宁,等.腔镜甲状腺切除术中喉返神经的显露[J].中国微创外科杂志,2013,13(6):560-562.[8]WANG B,XU X D,LIU N,et al.Exposure of recurrent laryngeal nerve in endoscopic thyroidectomy[J].Chinese Journal of Minimally Invasive Surgery,2013,13(6):560-562.Chinese
[9]冯铎,陶霖玉,徐菲.经胸乳入路腔镜甲状腺手术的临床应用[J].中国内镜杂志,2013,19(6):654-656.[9]FENG D,TAO L Y,XU F.Clinical application of endoscopic thyroidectomy via thoracic and mammary approach[J].China Journal of Endoscopy,2013,19(6):654-656.Chinese
[10]王洪华,杨国保,邱金中.腔镜下甲状腺手术180例体会[J].中国内镜杂志,2013,19(12):1340-1342.[10]WANG H H,YANG B G,QIU J Z.Edoscopic thyroidectomy in180 cases[J].China Journal of Endoscopy,2013,19(12):1340-1342.Chinese
[11]赵文新,王波,颜守义,等.针式辅助全腔镜甲状腺癌功能性颈淋巴结清扫:点线面结合的策略与技巧[J].中华外科杂志,2016,54(11):823-827.[11]ZHAO W X,WANG B,YAN S Y,et al.Strategy of points,lines and layers in needle assisted laparoscope functional modified neck dissection through bilateral breast approach[J].Chinese Journal of Surgery,2016,54(11):823-827.Chinese
[12]胡友主,李国新,王存川.完全乳晕入路与胸乳入路腔镜甲状腺切除术的临床比较[J].中国内镜杂志,2013,19(10):1053-1056.[12]HU Y Z,LI G X,WANG C C.Comparison between endoscopic thyroidectomy by completely areola approach and breast approach[J].China Journal of Endoscopy,2013,19(10):1053-1056.Chinese
[2]王存川,陈鋆,胡友主,等.内镜甲状腺切除术150例[J].中华外科杂志,2004,42(11):675-677.[2]WANG C C,CHEN Y,HU Y Z,et al.Endoscopic thyroidectomy with 150 cases[J].Chinese Journal of Surgery,2004,42(11):675-677.Chinese
[3]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):541-546.[3]WANG P,YAN H C.Endoscopic thyroid lobectomy via bilateral areolar approach-Wang’s seven-step method[J].Chinese Journal of General Surgery,2017,26(5):541-546.Chinese
[4]CARTY S E,COOPER D S,DOHERTY G M,et al.Consensus statement on the terminology and classifcation of central neck dissection for thyroid cancer[J].Thyroid,2009,19(11):1153-1158.
[5]冯萍,马立,余一萍,等.全乳晕入路与胸乳入路腔镜甲状腺手术临床对比研究[J].实用医学杂志,2015,31(14):2331-2333.[5]FENG P,MA L,YU Y P,et al.Clinical comparative study between endoscopic thyroidectomy by total areola approach and thoracic breast approach[J].The Journal of Practical Medicine,2015,31(14):2331-2333.Chinese
[6]李三荣,刘仁胜,张燕,等.腔镜甲状腺手术中喉返神经的显露与保护[J].中国微创外科杂志,2015,15(9):846-848.[6]LI S R,LIU R S,ZHANG Y,et al.Exposure and protection of recurrent laryngeal nerve in endoscopic thyroidectomy[J].Chinese Journal of Minimally Invasive Surgery,2015,15(9):846-848.Chinese
[7]贾高磊,田志龙,高新宝,等.腔镜甲状腺腺叶切除术喉返神经的保护体会[J].中国微创外科杂志,2016,16(11):1006-1008.[7]JIA G L,TIAN Z L,GAO X B,et al.Experience of protecting recurrent laryngeal nerve in endoscopic thyroidectomy[J].Chinese Journal of Minimally Invasive Surgery,2016,16(11):1006-1008.Chinese
[8]王波,徐旭东,刘宁,等.腔镜甲状腺切除术中喉返神经的显露[J].中国微创外科杂志,2013,13(6):560-562.[8]WANG B,XU X D,LIU N,et al.Exposure of recurrent laryngeal nerve in endoscopic thyroidectomy[J].Chinese Journal of Minimally Invasive Surgery,2013,13(6):560-562.Chinese
[9]冯铎,陶霖玉,徐菲.经胸乳入路腔镜甲状腺手术的临床应用[J].中国内镜杂志,2013,19(6):654-656.[9]FENG D,TAO L Y,XU F.Clinical application of endoscopic thyroidectomy via thoracic and mammary approach[J].China Journal of Endoscopy,2013,19(6):654-656.Chinese
[10]王洪华,杨国保,邱金中.腔镜下甲状腺手术180例体会[J].中国内镜杂志,2013,19(12):1340-1342.[10]WANG H H,YANG B G,QIU J Z.Edoscopic thyroidectomy in180 cases[J].China Journal of Endoscopy,2013,19(12):1340-1342.Chinese
[11]赵文新,王波,颜守义,等.针式辅助全腔镜甲状腺癌功能性颈淋巴结清扫:点线面结合的策略与技巧[J].中华外科杂志,2016,54(11):823-827.[11]ZHAO W X,WANG B,YAN S Y,et al.Strategy of points,lines and layers in needle assisted laparoscope functional modified neck dissection through bilateral breast approach[J].Chinese Journal of Surgery,2016,54(11):823-827.Chinese
[12]胡友主,李国新,王存川.完全乳晕入路与胸乳入路腔镜甲状腺切除术的临床比较[J].中国内镜杂志,2013,19(10):1053-1056.[12]HU Y Z,LI G X,WANG C C.Comparison between endoscopic thyroidectomy by completely areola approach and breast approach[J].China Journal of Endoscopy,2013,19(10):1053-1056.Chinese