Postauricular and Axillary Approach Endoscopic Neck Surgery: A New Technique
Postauricular and Axillary Approach Endoscopic Neck Surgery: A New Technique
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DOI：
10.1007/s00268-009-9922-8
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发表时间：
2009-04-01
影响因子：
2.6
通讯作者：
Youn, Yeo-Kyu
中科院分区：
文献类型：
--
作者：
Lee, Kyu Eun;Kim, Hoon Yub;Youn, Yeo-Kyu
虽然双侧腋窝乳房入路（BABA）的内镜颈部手术解决了各种良性和恶性甲状腺和甲状旁腺疾病，不良反应最小，美容效果极佳，但它涉及环锯切口。许多患者，尤其是年轻女性患者，不愿意让乳房受累。自2006年6月至2007年12月，我们采用经皮腋窝入路（PAA）对10例患者进行了内镜下颈部手术。用稀释的肾上腺素溶液皮下浸润后，解剖颈阔下和皮下间隙。使用两个腋窝端口和两个耳后端口，低压CO2吹入产生手术空间。在分离带状肌之间的中线后，分离峡部，用超声剪解剖甲状腺叶，并在仔细识别喉返神经和甲状旁腺后切除。恶性病变采用对侧甲状腺叶切除术治疗。对于甲状旁腺腺瘤，我们在中线分离带状肌后进行了甲状旁腺切除术。2例甲状腺叶切除术，1例甲状旁腺切除术，1例甲状腺次全切除术和6例甲状腺全切除术均采用PAA内镜颈部手术。平均手术时间为210.0 +/- A 43.7 min。没有病例转为开放手术、永久性声带麻痹或面神经麻痹。甲状腺切除术患者均未出现低钙血症。PAA内镜颈部手术是一种可行的甲状腺和甲状旁腺手术方法，允许良好的手术可视化，并具有最小的不良反应和良好的美容效果。
While the bilateral axillo-breast approach (BABA) to endoscopic neck surgery resolves various benign and malignant thyroid and parathyroid diseases with minimal adverse effects and excellent cosmetic outcomes, it involves circumareolar incisions. Many patients, especially young female patients, are reluctant to have their breast involved. Consequently, we developed the postauricular and axillary approach (PAA) that uses postauricular incisions.From June 2006 to December 2007, we treated 10 patients with PAA endoscopic neck surgery. After subcutaneous infiltration with diluted epinephrine solution, the subplatysmal and subcutaneous spaces were dissected. Two axillary ports and two postauricular ports were used and low-pressure CO2 insufflation generated operative space. After dividing the midline between the strap muscles, the isthmus was divided and the thyroid lobe was dissected with ultrasonic shears and excised after careful identification of the recurrent laryngeal nerve and parathyroid glands. Malignant lesions were treated with contralateral thyroid lobectomy. For parathyroid adenomas, we performed parathyroidectomy after dividing the strap muscles in the midline.Two thyroid lobectomies, one parathyroidectomy, one subtotal thyroidectomy, and six total thyroidectomies were performed by PAA endoscopic neck surgery. The mean operation time was 210.0 +/- A 43.7 min. There were no cases of conversion to open surgery, permanent vocal cord palsy, or facial nerve palsy. None of the thyroidectomy patients exhibited hypocalcemia. The cosmetic outcomes were excellent and all patients were satisfied.PAA endoscopic neck surgery is a feasible method for thyroid and parathyroid surgery that permits good operative visualization and has minimal adverse effects and excellent cosmetic outcomes.