Abstract:

Objective:To explore to simply the method of endoscopic thyroid surgery and to promote the application of endoscopic thyroid surgery in clinic. Methods:Fiftyfive patients underwent endoscopic thyroidectomy via the anterior chest wall approach between June 2004 and May 2007 in the Southwest Hospital of the Third Miliary Medical University.Of 55 patients, 40 cases suffered with thyroid adenoma including 15 in bilateral side,25 in half side and 1 in isthmic portion,and 15 cases suffered with nodular goiter.The size of mass was 05～60cm.Cervial plexum and local infiltration anaesthesia were performed in all patients. Trocars were inserted at 12cm below fossa suprasternalis.Skin flap was liberated between latissimus colli and anterior jugular muscles with electric knife. Linea alba cervicalis was opened by electric knife,anterior jungular muscles were liberated and drawn upward.The masses of thyroid were caught with no damage clamp and removed completely with ultrasound knife. Results:The effect of Cervial plexum and local infiltration anaesthesia were satisfying in 53 cases.Of 55 patients,25 patients undewent bilateral partial thyroidectomy,29 partial hemithyroidectomy,and 1 isthmic portion resection.The mean operation time was 95 (45～150) min.The complications occurred in 3 patients,including transient hoarseness in 1 patient on the second day after the operation and recovered well 1 month later. Conclusion:The endoscopic thyroid surgery could be completed with cervial plexum and local infiltration anaesthesia. The endoscopic manipulation could be simplified via anteria chest wall approach and with the suitable length of subcutaneous path (about 12cm ).The operation time could be shortened by using both electric knife and ultrasound knife.

Key words: endoscopic thyroid surgery, cervial plexum anaesthesia

摘要：

目的:探讨腔镜甲状腺手术的简便方法，促进腔镜甲状腺手术的应用。方法:第三军医大学西南医院乳腺中心自2004年6月至2007年5月采用前胸壁径路完成55例腔镜甲状腺手术，其中甲状腺腺瘤40例（双侧15例、单侧25例、峡部1例）,结节性甲状腺肿15例（双侧10例，单侧5例），肿块直径0.5～6.0cm。采用颈丛阻滞加局部浸润麻醉，在胸骨上窝下方约12cm处置入trocar，于颈前肌群浅面采用电凝钩游离皮瓣，切开颈白线后游离并悬吊颈前肌群，用无损伤抓钳提抓肿块表面组织，超声刀沿肿块周围切割即可将肿块完整切除或将腺叶部分切除。结果:55例中，53例颈丛麻醉加局麻后效果良好。双侧手术25例，单侧29例，峡部肿瘤切除1例。手术时间平均95min。结论:颈丛麻醉加局麻可以作为腔镜甲状腺手术麻醉方式；采用经胸壁径路及合适长度的皮下隧道（12cm左右）有利于简化手术操作；电刀和超声刀的配合使用可缩短手术时间。

关键词: 腔镜甲状腺切除术, 颈丛阻滞麻醉