摘要
目的:探讨双极电凝镊联合超声刀经颈部入路切除胸骨后甲状腺肿治疗经验。方法:回顾性分析2013年7月至2020年12月收治的34例胸骨后甲状腺肿患者的病例资料。结果:根据术前分型,其中Ⅰ型9例,Ⅱ型17例,Ⅲ型8例。34例患者中,无明显临床症状者23例,表现为怕热多汗者1例,表现为吞咽困难、呼吸困难、声音嘶哑等压迫症状者10例。术后病理显示:良性31例,甲状腺乳头状癌1例,甲状腺滤泡性癌1例,甲状腺神经鞘瘤1例。患者均首选经颈部入路手术,其中有4例联合了胸骨劈开术。术后并发症发生率8.8%(3/34),均为术后暂时性四肢麻木,补钙治疗后症状消失,均顺利出院。结论:经过充分的术前评估和准备,双极电凝镊联合超声刀经颈部入路切除胸骨后甲状腺肿是安全有效的,能在手术过程中实施“精细化解剖”,最大限度地保护甲状旁腺、喉返神经等甲状腺周围组织器官。
Objective To explore the diagnosis and treatment experience of bipolar coagulation forceps combined with ultrasonic knife transcervical approach for resection of retrosternal goiter.Methods The medical records of 34 patients with retrosternal goiter admitted from July 2013 to December 2020 were retrospectively reviewed.Results According to preoperative classification,there were 9 cases of typeⅠ,17 cases of typeⅡand 8 cases of typeⅢ.Among the 34 patients,23 cases had no obvious clinical symptoms,1 case showed fear of heat and hyperhidrosis,and 10 cases showed pressure symptoms such as dysphagia,dyspnea and hoarseness.Postoperative pathology showed that 31 cases were benign,1 case was papillary thyroid carcinoma,1 case was fllicular thyroid carcinoma,and 1 case was thyroid schwannoma.The transcervical approach was preferred in all patients,and four of them combined with sternotomy.The incidence of postoperative complications was 8.8%(3/34).All patients had temporary limb numbness after operation,and their symptoms disappeared after calcium supplementation.Conclusion After adequate preoperative evaluation and preparation,bipolar electrocoagulation forceps combined with ultrasonic knife is safe and effective in the transcervical approach to remove retrosternal goiter,which can perform"fine anatomy"during the operation,and maximize the protection of parathyroid gland,recurrent laryngeal nerve and other perithyroid tissues and organs.
作者
丁杰
陈虹
冯庆钊
苏磊
管文贤
Ding Jie;Chen Hong;Feng Qingzhao;Su Lei;Guan Wenxian(Department of General Surgery,Nanjing Drum Tover Hopial Clinical College of Nanjing Medical Uniersity,Nanjing Jiangsu Promince 210008,China)
出处
《中华普外科手术学杂志（电子版）》
2022年第6期659-662,共4页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
基金
国家自然科学基金(82172645)
国家重点研发计划(2016YFC0104105)
南京市医学科技发展项目(YKK17063)。
关键词
甲状腺肿
胸骨后
颈部入路
超声刀
双极电凝镊
Goiter,substemal
Cervical approach
Bipolar electric coagulation forceps
Ultrasonie knife
