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目的探讨经胸锁乳突肌前缘入路行甲状腺良性肿瘤切除术的体会。方法 2002年10月至2010年10月期间我院对128例甲状腺良性肿瘤患者行经胸锁乳突肌前缘入路甲状腺手术,手术切口采取皮内缝合。结果所有患者均顺利完成手术。手术时间45~130 min(平均65 min),术中出血10~100 ml(平均40 ml);引流管均在术后第2天拔除,引流量15~30 ml(平均20 ml);手术切口长3~7 cm(平均5 cm),均一期愈合;住院时间3~6 d(平均4.5 d)。术后无出血,无神经、甲状旁腺损伤及其他并发症。术后随访0.5~8年(平均5.5年),12例患者(9%)复发,复发时间为术后1~3年(平均1.5年);8例患者结节<1 cm,给予临床观察;其余4例患者经相同入路经二次手术治愈,随访无复发,未发现甲状腺癌。结论经胸锁乳突肌前缘入路行甲状腺良性肿瘤切除术不损伤或横断舌骨下肌群,术中出血少,无颈部肌肉瘢痕粘连影响外观之虑。
Objective To explore the experience of thyroidectomy for benign thyroidectomy via the anterior approach of sternocleidomastoid muscle. Methods From October 2002 to October 2010, 128 patients with thyroid benign tumor underwent thyroidectomy through the anterior margin of the sternocleidomastoid muscle in our hospital. The surgical incision was performed by intradermal suture. Results All patients successfully completed the operation. The operation time was 45 to 130 minutes (mean 65 minutes) and the intraoperative blood loss was 10 to 100 ml (average 40 ml). The drainage tube was removed on the second day after operation and the drainage volume was 15 to 30 ml (average 20 ml) Length of 3 ~ 7 cm (average 5 cm), all were healed; hospital stay 3 ~ 6 d (average 4.5 d). No postoperative bleeding, no nerve, parathyroid injury and other complications. The patients were followed up from 0.5 to 8 years (average 5.5 years), and 12 patients (9%) relapsed from 1 to 3 years after operation (mean 1.5 years). The nodules of 8 patients were less than 1 cm and were given clinical observation. The remaining 4 patients were treated by the same procedure by the second surgery, with no recurrence and no thyroid cancer. Conclusions The thyroidectomy approach does not damage or transect the subhygmus muscle during the thyroidectomy. There are few intraoperative bleeding and no muscular scar adhesion in the neck affect the appearance.