CAJ | 학술논문

目的探讨da Vinci Si机器人甲状腺手术不同径路的安全性.方法 2014年1月济南军区总医院用da Vinci Si外科手术系统完成甲状腺腺叶切除2例.1例取腋窝径路,于患侧腋窝沿腋前线取切口约5 cm,对侧锁骨中线乳头上方取横切口约8 mm,建立皮下隧道至术区,经腋窝切口置入da Vinci Si外科手术系统摄像臂及1、2号器械臂,经8 mm trocar置入3号器械臂.另一例取胸前径路,于胸骨切迹下约12 cm处建立观察孔12 mm,双侧锁骨中线乳晕上方处建立操作孔8 mm,观察孔置入摄像臂,操作孔置入1、2号器械臂,术中止血及腺体切除均采用超声刀,标本用取物袋取出,术毕于术区留置负压引流管并关闭手术切口.结果 2例患者均成功实施机器人甲状腺腺叶切除术,无中转开放或腔镜手术,无手术并发症,术中估计出血量10 ～20 mL,平均手术时间为163 min,平均引流量90.5 mL.病理诊断分别为结节性甲状腺肿和甲状腺滤泡性腺瘤.术后测甲状旁腺素及血清钙磷均在正常范围.结论经腋窝与胸前径路机器人甲状腺腺叶切除安全可行,手术美容效果好.
목적 탐토da Vinci Si궤기인갑상선수술불동경로적안전성.방법 2014년1월제남군구총의원용da Vinci Si외과수술계통완성갑상선선협절제2례.1례취액와경로,우환측액와연액전선취절구약5 cm,대측쇄골중선유두상방취횡절구약8 mm,건립피하수도지술구,경액와절구치입da Vinci Si외과수술계통섭상비급1、2호기계비,경8 mm trocar치입3호기계비.령일례취흉전경로,우흉골절적하약12 cm처건립관찰공12 mm,쌍측쇄골중선유훈상방처건립조작공8 mm,관찰공치입섭상비,조작공치입1、2호기계비,술중지혈급선체절제균채용초성도,표본용취물대취출,술필우술구류치부압인류관병관폐수술절구.결과 2례환자균성공실시궤기인갑상선선협절제술,무중전개방혹강경수술,무수술병발증,술중고계출혈량10 ～20 mL,평균수술시간위163 min,평균인류량90.5 mL.병리진단분별위결절성갑상선종화갑상선려포성선류.술후측갑상방선소급혈청개린균재정상범위.결론 경액와여흉전경로궤기인갑상선선협절제안전가행,수술미용효과호.
Objective To evaluate the clinical application and superiority of da Vinci Si surgical system in thyroidectomy.Methods Robotic-assisted thyroidectomy was done for two patients in Jinan Military General Hospital of PLA on January 23 and 24,2014.In one patient,a 5 cm vertical skin incision as well as a 8mm transverse incision were performed in the anterior affected sideaxillary fold and the middle of the contralateral chest wall,respectively.Patient positioned and working space established prior to docking the robot.The camera and working arms are then positioned.The camera arm is centered in the working space.Two working arms are then placed adjacent to the camera.The third working arm is placed through the small medially place incision.In another patient,robotic-assisted thyroidectomy by the anterior chest approach was taken.Focus scalpel was used for hemostasis and gland resection,and dissected tissues were took out by a specimen pouch.Vacuum-assisted closure was placed and then suture incision was made after pathology confirm benign in operation.Results Unilateral thyroidectomy in two patients were successfully performed by da Vinci Si surgical system.There were no operation related complications and without conversions to open or endoscopic surgery.Blood lose during operation was about 10-20 mL.Mean operation time was 163 minutes and postoperative drainage volume was 90.5 mL.Pathological diagnosis were nodular goiter and thyroid follicular neoplasia.Parathyroid hormone,serum Ca and P were measured postoperative and the level were in the normal rage.Conclusion Robotic-assisted thyroidectomy using a axillary approach or anterior chest approach is a safe,feasible,and cosmetically good procedure.