腔镜下改良甲状腺次全切除术治疗原发性甲状腺功能亢进
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摘要
目的探讨胸乳入路腔镜下改良甲状腺次全切除术(一侧甲状腺全切除或近全切除+一侧甲状腺次全切除)治疗原发性甲状腺功能亢进(甲亢)的疗效及安全性。方法 2014年10月~2016年10月对39例甲亢行胸乳入路腔镜下甲状腺左叶全切除或近全切除联合甲状腺右叶次全切除的改良手术,保留甲状腺右叶组织约6 g。结果腔镜下顺利完成手术38例,1例因偏瘦、甲状腺体积大、操作空间小、术中出血而中转开放手术。手术平均时间100 min(85~135 min),术中平均出血量35 ml(10~60 ml)。术后引流管平均引流量50 ml(30~95 ml),术后常规第2天拔出引流管。术后平均住院3.3 d(2~5 d)。术后无声嘶、饮水呛咳、手足麻木及抽搐,无切口出血所致呼吸困难、甲亢危象及死亡。38例腔镜手术患者对美容效果非常满意。39例平均随访15个月(2~26个月),2例出现甲状腺功能减低,1例甲亢复发,其余患者甲状腺功能正常。结论胸乳入路腔镜下改良甲状腺次全切除术治疗甲亢安全、有效,兼具美容效果,患者满意度高。
Objective To investigate the safety and efficacy of endoscopic modified subtotal thyroidectomy( total or near-total thyroidectomy for one thyroid lobe,and subtotal thyroidectomy for the other lobe) via thoracic and breast approach for primary hyperthyroidism. Methods A total of 39 patients with primary hyperthyroidism receiving endoscopic modified subtotal thyroidectomy( total or near-total thyroidectomy for the left lobe and subtotal thyroidectomy for the right lobe,with thyroid remnant tissue about 6 g)were enrolled from October 2014 to October 2016. Results The operations were successfully performed under endoscopy in 38 cases and one case was converted to open surgery due to low body weight,large thyroid volume,small surgical space and intraoperative bleeding. The mean operation time was 100 min( range,85-135 min),the mean intraoperative blood loss was 35 ml( range,10-60 ml),and the mean postoperative drainage was 50 ml( range,30-95 ml). All the drainages were pulled out 2 days postoperatively and the mean postoperative hospital stay was 3. 3 d( range,2-5 d). No hoarseness,choking in drinking water,or numbness and twitching of hand and foot occurred. None of the patients appeared dyspnea,hyperthyroidism crisis or death. The 38 cases of endoscopic surgery were satisfactory with cosmetic outcomes. The mean follow-up time was 15 months( range,2-26 months). There were 2 patients with hypothyroidism and 1 patient with recurrent hyperthyroidism. Conclusion Endoscopic modified subtotal thyroidectomy for primary hyperthyroidism is safe and effective with favorable cosmetic effects.
Objective To investigate the safety and efficacy of endoscopic modified subtotal thyroidectomy( total or near-total thyroidectomy for one thyroid lobe,and subtotal thyroidectomy for the other lobe) via thoracic and breast approach for primary hyperthyroidism. Methods A total of 39 patients with primary hyperthyroidism receiving endoscopic modified subtotal thyroidectomy( total or near-total thyroidectomy for the left lobe and subtotal thyroidectomy for the right lobe,with thyroid remnant tissue about 6 g)were enrolled from October 2014 to October 2016. Results The operations were successfully performed under endoscopy in 38 cases and one case was converted to open surgery due to low body weight,large thyroid volume,small surgical space and intraoperative bleeding. The mean operation time was 100 min( range,85-135 min),the mean intraoperative blood loss was 35 ml( range,10-60 ml),and the mean postoperative drainage was 50 ml( range,30-95 ml). All the drainages were pulled out 2 days postoperatively and the mean postoperative hospital stay was 3. 3 d( range,2-5 d). No hoarseness,choking in drinking water,or numbness and twitching of hand and foot occurred. None of the patients appeared dyspnea,hyperthyroidism crisis or death. The 38 cases of endoscopic surgery were satisfactory with cosmetic outcomes. The mean follow-up time was 15 months( range,2-26 months). There were 2 patients with hypothyroidism and 1 patient with recurrent hyperthyroidism. Conclusion Endoscopic modified subtotal thyroidectomy for primary hyperthyroidism is safe and effective with favorable cosmetic effects.
引文
1 Michael SS,Michael WM,eds.Operative techniques in breast,endocrine,and oncologyic surgery.1sted.Philadelphia:Wolters Kluwer,2015.318.
2 鲁瑶,黄林平,路夷平,等.经胸乳途径内镜手术治疗甲状腺功能亢进.中国微创外科杂志,2011,11(7):601-603.
3 Gagner M.Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism.Br J Surg,1996,83(6):875.
4 Hüscher CS,Chiodini S,Napolitano C,et al.Endoscopic right thyroid lobectomy.Surg Endosc,1997,22(8):877.
5 Zhang W,Jiang DZ,Liu S,et al.Current status of endoscopic thyroid surgery in China.Surg Laparosc Endosc Percutan Tech,2011,21(2):67-71.
6 王平,赵群仔.腔镜下甲状腺切除术的回顾与展望.中华外科杂志,2016,54(11):815-818.
7 陈孝平,汪建平,主编.外科学.第8版.北京:人民卫生出版社,2013.241.
8 Palit TK,Miller CR,Miltenburg DM.The efficacy of thyroidectomy for Graces’disease:A meta-analysis.J Surg Res,2000,90(2):161-165.
9 黎东伟,李君久,熊秋华,等.腔镜甲状腺次全切除术在原发性甲状腺功能亢进外科治疗中的应用.中国微创外科杂志,2016,16(8):749-751.
10 何仕青,伍宏章,袁超杰,等.腔镜与传统手术治疗甲状腺功能亢进症的临床效果比较.浙江临床医学,2012,14(6):680-682.
2 鲁瑶,黄林平,路夷平,等.经胸乳途径内镜手术治疗甲状腺功能亢进.中国微创外科杂志,2011,11(7):601-603.
3 Gagner M.Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism.Br J Surg,1996,83(6):875.
4 Hüscher CS,Chiodini S,Napolitano C,et al.Endoscopic right thyroid lobectomy.Surg Endosc,1997,22(8):877.
5 Zhang W,Jiang DZ,Liu S,et al.Current status of endoscopic thyroid surgery in China.Surg Laparosc Endosc Percutan Tech,2011,21(2):67-71.
6 王平,赵群仔.腔镜下甲状腺切除术的回顾与展望.中华外科杂志,2016,54(11):815-818.
7 陈孝平,汪建平,主编.外科学.第8版.北京:人民卫生出版社,2013.241.
8 Palit TK,Miller CR,Miltenburg DM.The efficacy of thyroidectomy for Graces’disease:A meta-analysis.J Surg Res,2000,90(2):161-165.
9 黎东伟,李君久,熊秋华,等.腔镜甲状腺次全切除术在原发性甲状腺功能亢进外科治疗中的应用.中国微创外科杂志,2016,16(8):749-751.
10 何仕青,伍宏章,袁超杰,等.腔镜与传统手术治疗甲状腺功能亢进症的临床效果比较.浙江临床医学,2012,14(6):680-682.