摘要
目的探讨基于筋膜解剖建立经腋窝无充气后入路腔镜甲状腺手术空间的安全性和有效性。方法回顾性分析2021年6—12月南方医科大学南方医院甲状腺疝外科连续收治的行经腋窝无充气腔镜甲状腺手术的276例病人的临床资料,均基于颈深筋膜解剖建立手术空间。观察记录术中及术后情况,并于手术后第2天以及术后3、6个月进行随访。结果手术时间为80.5(60~115)min,手术空间建立时间为18(12~26)min。术中出血5(1~15)m L。术中颈外静脉及属支出血2例,颈前静脉出血1例。术后住院时间为2.5(1~4)d。术后第2天评估锁骨区域感觉恢复评分:S3级221例(80.1%),S2级55例(19.9%),无S4、S3+、S1及S0级病例;术后3个月:S3+/S4级245例(88.8%),S3级30例(10.9%),S2级1例(0.4%);术后6个月:S3+/S4级270例(97.8%),S2级6例(2.2%),无术后皮瓣区域积液。所有病例均完成随访,术后2例病人出现暂时性声音嘶哑,术后3个月随访时声音恢复,术后无淋巴瘘、Horner综合征、出血和胸锁乳突肌肿胀,无复发病例。结论经腋窝无充气腔镜甲状腺手术中,基于筋膜解剖建立手术空间方法安全且有效,建议作为常规操作方法。
Objective To investigate the safety and effectiveness of establishing a transaxillary lumpectomy space for lumpectomy thyroid surgery without inflatable posterior approach based on the deep cervical fascial anatomy.Methods The clinical data of 276 consecutive patients admitted to the Department of Thyroid Hernia Surgery,Southern Hospital of Southern Medical University from June to December 2021 who underwent transaxillary lumpectomy thyroid surgery were retrospectively analyzed,and the surgical space was established based on fascial anatomy.Intraoperative and postoperative conditions were observed and recorded,and follow-up was performed on the second day after surgery and at 3 and 6 months after surgery.Results The operative time was 80.5(60-115)min and the operative space was established in 18(12-26)min.Intraoperative bleeding was 5(1-15)mL.There were 2 cases of intraoperative extra-jugular venous and genera expenditure blood and 1 case of intraoperative anterior jugular vein bleeding.The postoperative hospital stay was 2.5(1-4)d.Sensory recovery scores in the clavicular region were assessed on the second postoperative day:221(80.1%)S3,55(19.9%)S2,no S4,S3+,S1 or S0 cases;3 months postoperatively:245(88.8%)S3+/S4,30(10.9%)S3 and 1(0.4%)S2;6 months postoperatively:270(97.8%)S3+/S4,6(2.2%)S2,no postoperative flap area effusion.Follow-up was completed in all cases.Two patients had temporary hoarseness after surgery and voice was restored at the 3-month postoperative follow-up.There were no postoperative lymphatic fistulas,Horner's syndrome,postoperative bleeding or swelling of the sternocleidomastoid muscle,and no recurrent cases.Conclusion The fascial anatomy-based method of transaxillary uninflated lumpectomy thyroid surgery space creation is safe and effective and can be used as a routine method.
作者
葛军娜
谭洁
余诗桐
陈伟生
张植诚
李婷婷
孙百慧
魏志刚
雷尚通
GE Jun-na;TAN Jie;YU Shi-tong(Department of Thyroid and Hernia Surgery,Nanfang Hospital,the First School of Clinical Medicine,Southern Medical University,Guangzhou 510515,China)
出处
《中国实用外科杂志》
CAS
CSCD
北大核心
2023年第4期440-443,共4页
Chinese Journal of Practical Surgery
基金
国家自然科学基金(No.82203778)
广州市科技计划项目(No.202102020180)
广东省基础与应用基础研究基金(No.2020A1515110925,No.2022A1515010621)。
关键词
腔镜
甲状腺
腋窝入路
手术空间
颈深筋膜
胸大肌筋膜
endoscopy
thyroid
axillary approach
surgical space
deep cervical fascia
fascia of pectoralis major
