西安交通大学学报（医学版）2024，Vol.45Issue(1)：87-93,7.DOI:10.7652/jdyxb202401015
无充气腋窝入路腔镜甲状腺手术空间构建的常见问题及解决思路
Common challenges and resolutions in the spatial construction of endoscopic thyroid surgery using a gasless axillary approach
摘要
Abstract
Objective To enhance the standardization of surgical operations,shorten the learning curve,and reduce surgical complications by summarizing common errors and proposing solutions for beginners during pre-study of cavity construction in non-inflatable axillary approach laparoscopic thyroid surgery.Methods A retrospective analysis was made on 210 patients who underwent noninflatable axillary approach luminal thyroid surgery at the Department of Head and Neck Surgery,Zhejiang Provincial People's Hospital,between January 2022 and June 2023.Among them,150 patients were luminalized by the practitioners in the practice group,while 60 patients were luminalized by the practitioners in the skilled group.The occurrence of nine common errors during cavity construction,such as supraclavicular nerve injury and scapulohumeral muscle injury,was assessed and compared between the two groups.Results There was no statistically significant difference in age,gender,tumor diameter,tumor location or pathology type between the two groups(P＞0.05).The staff in the practice group had a significant difference in supraclavicular cutaneous nerve injury(19.33％vs.3.33％),scapulohumeral muscle injury or disarticulation(16.00％vs.0),anterior cervical band of free excess(24.00％vs.3.33％),pectoralis major muscle and supraclavicular fascia injury(16.00％vs.5.00％),external jugular vein and genuine branch injury(8.00％vs.0),excessive freeing of the sternoclavicular joint(7.33％vs.0),and incorrect entry of the sternocleidomastoid muscle gap(8.67％vs.0)were significantly higher in incidence than the employees in the skilled group(P＜0.05).There was no statistically significant difference between employees in the practice group and those in the skilled group in terms of injury to the internal jugular vein and its geniculate branches(4.00％vs.0),and incorrect entry of the anterior cervical strap muscles into the hierarchy(2.00％vs.0)(P＞0.05).Conclusion The incidence of damage to the surrounding tissue was significantly higher in the novice group than in the expert group during endoscopic thyroid surgery for space construction.A solid anatomical foundation and proficient endoscopic surgical technique serve as fundamental prerequisites for achieving a successful space system construction.By summarizing common challenges and providing corresponding solutions encountered during endoscopic thyroid surgery,this study further enhances and refines the learning system for total endoscopic thyroid procedures.关键词
甲状腺切除术/腔镜/腋窝入路/空间构建Key words
thyroidectomy/endoscopy/axillary approach/spatial construction分类
医药卫生引用本文复制引用
蒋烈浩,刘清,凌枭凯,王佳峰,徐加杰,谭卓,葛明华,郑传铭..无充气腋窝入路腔镜甲状腺手术空间构建的常见问题及解决思路[J].西安交通大学学报（医学版）,2024,45(1):87-93,7.基金项目
浙江省医药卫生科技项目(No.2022KY525) （No.2022KY525）
浙江省自然科学基金(No.Y23H160156)Supported by the Zhejiang Medical and Health Science and Technology Project(No.2022KY525)and Natural Science Foundation of Zhejiang Province(No.Y23H160156) （No.Y23H160156）
