CAJ | 학술논문

目的探讨经胸乳入路内镜甲状腺手术的方法、可行性、安全性.方法回顾性分析行胸乳入路内镜甲状腺切除术62例的临床资料,其中原发性甲状腺机能亢进4例、甲状腺腺瘤21例、结节性甲状腺肿36例和甲状腺癌1例.结果成功完成手术60例,2例中转开放手术.手术时间(126.2±27.0)min,术中失血平均15.5ml,均未输血.术后2d～3d拔除引流管.术后平均住院时间4.1d,平均住院费用为14 510元,本院同期开放甲状腺手术患者住院费用平均为4 700元,两者比较差异有统计学意义(P<0.05).手术方式包括甲状腺肿瘤切除11例,甲状腺单叶次全切除23例,双叶次全切除27例,甲状腺癌根治性切除1例.甲状腺肿块长径最大4.0cm.术后均无并发症.术后随访,失访2例,58例随访3～60个月(平均20个月),3例结节性甲状腺肿术后复发小结节,原发性甲状腺机能亢进症术后无复发.患者均对手术美容效果满意.1例甲状腺癌目前仍生存,并继续随访.结论经胸乳入路内镜甲状腺切除术是一种安全而可行的手术方法,手术视野清晰,显露神经清楚,具有显著美容效果.但该方法仍有一定的并发症发生率,费用较开放手术高,因此仍有待改进.
목적 탐토경흉유입로내경갑상선수술적방법、가행성、안전성.방법 회고성분석행흉유입로내경갑상선절제술62례적림상자료,기중원발성갑상선궤능항진4례、갑상선선류21례、결절성갑상선종36례화갑상선암1례.결과 성공완성수술60례,2례중전개방수술.수술시간(126.2±27.0)min,술중실혈평균15.5ml,균미수혈.술후2d～3d발제인류관.술후평균주원시간4.1d,평균주원비용위14 510원,본원동기개방갑상선수술환자주원비용평균위4 700원,량자비교차이유통계학의의(P<0.05).수술방식포괄갑상선종류절제11례,갑상선단협차전절제23례,쌍협차전절제27례,갑상선암근치성절제1례.갑상선종괴장경최대4.0cm.술후균무병발증.술후수방,실방2례,58례수방3～60개월(평균20개월),3례결절성갑상선종술후복발소결절,원발성갑상선궤능항진증술후무복발.환자균대수술미용효과만의.1례갑상선암목전잉생존,병계속수방.결론 경흉유입로내경갑상선절제술시일충안전이가행적수술방법,수술시야청석,현로신경청초,구유현저미용효과.단해방법잉유일정적병발증발생솔,비용교개방수술고,인차잉유대개진.
Objective To discuss the method,the safety,the advantages and disadvantages of endoscopic thyroidectomy via chest and breasts.Methods From Mar 2004 to Jun 2009,endoscopic thyroidectomy via anterior chest and breast approach was performed in 62 patients,including 4 cases of Grave's disease(1 case had history of an open operation),21 cases of thyroidadenoma,36 cases of nodular goiter,and 1 case of thyroid carcinoma.11 cases underwent adenoma resection,23 cases underwent unilateral subtotal lobectomy,27 cases underwent bilateral subtotal lobectomy,one thyroid carcinoma underwent curative resection.Their clinical data were collected and analyzed retrospectively.Results The endoscopic thyroidectomy was successfully carried out in 60 cases.The mean operative time was 126.2 min.Mean operative blood loss was 15.5 ml,no cases needed blood transfusion.The draining tube was moved 2 or 3 days after operation.Postoperative hospital mean stay 4.1days.The hospital mean expenses 14 510 yuan,the mean expenses of open thyroidecotmy patiens of the same term was 4 700 yuan.There was significant difference between endoscopic and conventional thyroidectomy on expense(P<0.05).58 patients during postoperative follow-up from 3 to 60 months were satisfied with the cosmetic effect and compararive curative effect as conventional surgery was obtained.However,3 cases of nodular goiter recurred.No recurrence was found in Graves's disease patients.One thyroid carcinoma patient was regularly followed.Conclusions Endoscopic thyroidectomy is a safe and effective method for thyroid diseases.The exposure is clear and nerves are exposed clearly.The cosmetic effect of this method is obvious.Some disadvantages such as complications and higher costs are needed to be improved.