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[经口甲状腺及甲状旁腺手术的适应证与技术]

[Indications and technique for transoral thyroid gland and parathyroid gland surgery].

作者信息

Schopf S, Umschlag C, Mechera R, Karakas E

机构信息

InnKlinikum Altötting und Mühldorf, Krankenhausstr. 1, 84453, Mühldorf, Deutschland.

Spital Männedorf, Männedorf, Schweiz.

出版信息

Chirurgie (Heidelb). 2024 Oct;95(10):801-809. doi: 10.1007/s00104-024-02118-6. Epub 2024 Aug 28.

Abstract

The conventional Kocher collar incision is the standard access to the thyroid and parathyroid glands. Although the incision length has been significantly shortened in recent years with this approach, there is increasing interest among patients in a surgical technique without visible scars in the décolleté. Transoral endoscopic thyroid gland surgery via the vestibular approach (TOETVA) is a modern technique that can be learned relatively quickly and leaves no visible scars because it is carried out exclusively through a natural orifice (natural orifice transluminal endoscopic surgery, NOTES). For retrieval of larger specimens, the transoral approach can be combined with a retroauricular access and thus covers a larger range of indications. The indications must be strictly followed, analogous to conventional surgery. Once the transoral access has been established, the operation is carried out as in open surgery but strictly from cranial to caudal. The classical complications are comparable to the results of conventional surgery. Specific complications include perioral, mandibular or cervical dysesthesia and hypesthesia.

摘要

传统的科赫尔领口切口是甲状腺和甲状旁腺手术的标准入路。尽管近年来采用这种方法切口长度已显著缩短,但患者对一种在颈部不留可见瘢痕的手术技术的兴趣与日俱增。经口前庭入路内镜甲状腺手术(TOETVA)是一种现代技术,相对容易掌握,且不会留下可见瘢痕,因为它完全通过自然腔道进行(自然腔道内镜手术,NOTES)。为了取出较大标本,经口入路可与耳后入路相结合,从而扩大适应证范围。与传统手术一样,必须严格遵循适应证。一旦建立经口入路,手术操作与开放手术相同,但必须严格从颅侧向尾侧进行。经典并发症与传统手术结果相当。特殊并发症包括口周、下颌或颈部感觉异常和感觉减退。

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