Jin Xiaojian, Lu Bangyu, Cai Xiaoyong, Huang Yubin, Huang Lulu, Lu Wenqi, Yan Yihe, Li Jianjun
From the *Department of General Surgery, The First Affiliated Hospital of Guangxi Medical University (West), Nanning; and †Guangxi Medical University, Nanning, Guangxi, China.
J Craniofac Surg. 2014 May;25(3):738-41. doi: 10.1097/SCS.0000000000000721.
The most commonly used minimally invasive thyroid surgery via noncervical approach is the bilateral breast approach, but there was usually a scar in the chest wall, which induced uncomfortable and bad cosmetic result. For this reason, endoscopic thyroidectomy via bilateral breast and ipsilateral axillary approach had been developed. The aims of this study are to analyze our surgical outcomes and to evaluate the effectiveness and safety. Between May 2011 and August 2012, 64 patients with thyroid diseases underwent endoscopic thyroidectomy via bilateral breast and ipsilateral axillary approach. The patients' clinical data, operative time, blood loss, drainage amounts, complications, hospital stay, area of skin flap, and postoperative visual analog pain score (VAS) were analyzed retrospectively. We describe here the details of our operative technique. All the 64 patients successfully underwent endoscopic thyroidectomy. None had to be converted, and no postoperative complications were observed. Mean operation time was 104.0 ± 25.3 minutes. Mean blood loss was 10.5 ± 3.7 mL. Mean average area of skin flap was 78.6 ± 8.6 cm2. Mean postoperative drainage amounts on day 1 were 84.5 ± 62.6 mL. Mean hospital stay was 2 to 3 days. The postoperative VAS scores on day 1 were 0 to 2. Follow-up visits range from 2 to 12 months, suggesting that no one had a relapse. Furthermore, the patients were uniformly pleased with the cosmetic results of the operation. Bilateral breast and ipsilateral axillary approach is a safe and easily popularized method that gives good surgical completeness, quick recovery, less pain, less postoperative complications, and an excellent cosmetic result. Therefore, this method is a good choice for patients with surgical thyroid diseases.
最常用的非颈部入路微创甲状腺手术是双侧乳晕入路，但胸壁通常会留下疤痕，这会导致不适且美容效果不佳。因此，双侧乳晕及同侧腋窝入路内镜甲状腺切除术应运而生。本研究的目的是分析我们的手术结果，并评估其有效性和安全性。2011年5月至2012年8月期间，64例甲状腺疾病患者接受了双侧乳晕及同侧腋窝入路内镜甲状腺切除术。回顾性分析患者的临床资料、手术时间、出血量、引流量、并发症、住院时间、皮瓣面积及术后视觉模拟疼痛评分（VAS）。在此，我们描述我们的手术技术细节。所有64例患者均成功接受了内镜甲状腺切除术。无一例中转手术，未观察到术后并发症。平均手术时间为104.0±25.3分钟。平均出血量为10.5±3.7毫升。平均皮瓣面积为78.6±8.6平方厘米。术后第1天平均引流量为84.5±62.6毫升。平均住院时间为2至3天。术后第1天VAS评分为0至2分。随访时间为2至12个月，表明无一例复发。此外，患者对手术的美容效果均表示满意。双侧乳晕及同侧腋窝入路是一种安全且易于推广的方法，手术完整性好、恢复快、疼痛轻、术后并发症少且美容效果极佳。因此，该方法是甲状腺疾病手术患者的理想选择。
