经胸乳入路腔镜甲状腺手术过程中甲状旁腺的识别与保护的体会(1)
【摘要】 目的 探讨经胸乳入路腔镜甲状腺手术过程中对甲状旁腺的识别与保护方法。方法 23例甲状腺手术患者为研究对象， 患者均采用经胸乳入路腔镜甲状腺手术治疗， 术中依据甲状旁腺的解剖位置、外观、对缺血耐受情况以及必要时的病理检查等综合因素识别并保护甲状旁腺， 观察其效果。结果 1例患者因术中出血中转传统手术， 2例患者因术后常规病理为甲状腺乳头状癌中转传统二次手术(腔镜手术早期阶段)， 1例术后短暂声音嘶哑(持续1 d)术后恢复正常， 1例患者术中病理为甲状腺腺瘤而术后常规病理为甲状腺乳头状癌行二次腔镜手术， 1例患者术后出现饮水呛咳予以甲钴胺及地塞米松治疗后恢复正常， 术后均无甲状旁腺功能不全导致的手脚麻木及抽搐， 术后无迟发性出血二次手术、无乳糜漏、皮瓣坏死、纵隔气肿等。结论 腔镜的放大作用在甲状腺手术中具有独特的优势， 有利于寻找重要的解剖结构并作出相应的保护。
【关键词】 甲状腺;腔镜手术;甲状旁腺;识别与保护
【Abstract】 Objective To discuss the recognition and protection method of parathyroid glands during endoscopic thyroidectomy via breast-thoracic approach. Methods A total of 23 patients undergoing thyroidectomy were treated by endoscopic thyroidectomy via breast-thoracic approach. The parathyroid glands were identified and protected according to the anatomical location， appearance， ischemic tolerance and pathological examination when necessary. The effect was observed. Results 1 patient was converted to traditional surgery because of intraoperative bleeding， 2 patients with thyroid papillary carcinoma were converted to traditional second operation (early stage of endoscopic surgery) because of the routine pathology after operation， 1 patient recovered from temporary hoarseness (lasting for 1 d)， 1 patient had intraoperative pathology as thyroid adenoma and postoperative routine pathology as thyroid papillary carcinoma， and underwent second laparoscopic surgery， and 1 patient developed cough after drinking water and recovered to normal after treatment with mecobalamin and dexamethasone. There was no parathyroid insufficiency resulted in numbness and convulsions of hands and feet， no delayed bleeding， no chylous leakage， skin flap necrosis， mediastinal emphysema and so on. Conclusion Laparoscopic magnification has unique advantages in thyroid surgery， and it is conducive to finding important anatomical structures and making corresponding protection.
【Key words】 Parathyroid glands; Endoscopic surgery; Parathyroid gland; Recognition and protection
隨着科学技术的发展和进步、腔镜技术也有了突飞猛进的发展， 90年代以后腔镜技术在全世界得到广泛推广， 病种也从单一的胆囊切除术扩大到外科的许多领域;同样如此， 由于腔镜具有美容、微创、恢复快等优点， 腔镜技术在甲状腺外科领域的应用也得到广大患者的青睐， 特别是年轻爱美女性患者。随着甲状腺腔镜手术经验的积累、先进科技的进步及应用于临床、手术方式的不断改进， 腔镜甲状腺的手术禁忌证也逐渐缩小， 而适应证越来越广泛， 术中的操作也逐渐精细化和规范化， 对各种并发症的预防如喉上神经、喉返神经及甲状旁腺的识别与保护方面有很好的认识与发展;随着外科医师对这些重要结构的解剖位置、常见变异及血供保护的基础研究与临床研究的逐渐深入， 腔镜甲状腺手术对神经的保护在技术层面上得到解决， 但在保护甲状旁腺方面尚处于探索阶段。甲状旁腺损失一直是阻碍甲状腺外科发展的阻碍， 也是甲状腺手术后引起纠纷的高发因素[1]。参考文献[2]报道甲状腺术后暂时性和永久性甲状旁腺功能低下的发生率分别为14%～60%和4%～11%。本科从2014年至今， 完成腔镜下甲状腺手术23例， 现将作者在腔镜甲状腺手术过程中甲状旁腺识别与保护的体会分享如下。, 百拇医药(卢亚 严顺新)
【关键词】 甲状腺;腔镜手术;甲状旁腺;识别与保护
【Abstract】 Objective To discuss the recognition and protection method of parathyroid glands during endoscopic thyroidectomy via breast-thoracic approach. Methods A total of 23 patients undergoing thyroidectomy were treated by endoscopic thyroidectomy via breast-thoracic approach. The parathyroid glands were identified and protected according to the anatomical location， appearance， ischemic tolerance and pathological examination when necessary. The effect was observed. Results 1 patient was converted to traditional surgery because of intraoperative bleeding， 2 patients with thyroid papillary carcinoma were converted to traditional second operation (early stage of endoscopic surgery) because of the routine pathology after operation， 1 patient recovered from temporary hoarseness (lasting for 1 d)， 1 patient had intraoperative pathology as thyroid adenoma and postoperative routine pathology as thyroid papillary carcinoma， and underwent second laparoscopic surgery， and 1 patient developed cough after drinking water and recovered to normal after treatment with mecobalamin and dexamethasone. There was no parathyroid insufficiency resulted in numbness and convulsions of hands and feet， no delayed bleeding， no chylous leakage， skin flap necrosis， mediastinal emphysema and so on. Conclusion Laparoscopic magnification has unique advantages in thyroid surgery， and it is conducive to finding important anatomical structures and making corresponding protection.
【Key words】 Parathyroid glands; Endoscopic surgery; Parathyroid gland; Recognition and protection
隨着科学技术的发展和进步、腔镜技术也有了突飞猛进的发展， 90年代以后腔镜技术在全世界得到广泛推广， 病种也从单一的胆囊切除术扩大到外科的许多领域;同样如此， 由于腔镜具有美容、微创、恢复快等优点， 腔镜技术在甲状腺外科领域的应用也得到广大患者的青睐， 特别是年轻爱美女性患者。随着甲状腺腔镜手术经验的积累、先进科技的进步及应用于临床、手术方式的不断改进， 腔镜甲状腺的手术禁忌证也逐渐缩小， 而适应证越来越广泛， 术中的操作也逐渐精细化和规范化， 对各种并发症的预防如喉上神经、喉返神经及甲状旁腺的识别与保护方面有很好的认识与发展;随着外科医师对这些重要结构的解剖位置、常见变异及血供保护的基础研究与临床研究的逐渐深入， 腔镜甲状腺手术对神经的保护在技术层面上得到解决， 但在保护甲状旁腺方面尚处于探索阶段。甲状旁腺损失一直是阻碍甲状腺外科发展的阻碍， 也是甲状腺手术后引起纠纷的高发因素[1]。参考文献[2]报道甲状腺术后暂时性和永久性甲状旁腺功能低下的发生率分别为14%～60%和4%～11%。本科从2014年至今， 完成腔镜下甲状腺手术23例， 现将作者在腔镜甲状腺手术过程中甲状旁腺识别与保护的体会分享如下。, 百拇医药(卢亚 严顺新)