颈侧区入路小切口甲状旁腺切除术治疗单发性甲状旁腺腺瘤  

Solitary Parathyroid Adenoma Resection by Focused Parathyroidectomy Through Lateral Cervical Approach

作　　者：孙滨 郭伯敏 康杰 邓先兆 王宗平 樊友本 

机构地区：[1]上海交通大学附属上海第六人民医院普外科上海交通大学甲状腺疾病诊治中心,200233

出　　处：《医学研究杂志》2017年第12期124-128,共5页Journal of Medical Research

摘　　要：目的探讨颈侧区入路小切口甲状旁腺切除术治疗单发性甲状旁腺腺瘤的有效性及安全性。方法笔者回顾性分析了250例单发性甲状旁腺腺瘤患者。87例患者行传统颈正中切口颈部探查术,70例患者行改良Miccoli腔镜甲状旁腺手术及93例行颈侧区小切口甲状旁腺切除术。记录3组术前、术后及随访期内相关生化指标并比较3组的术后并发症、麻醉方式、手术时间、住院天数、伤口长度。结果传统颈部探查术组及颈侧区小切口组中各有1例复发,行再次手术,其余患者均经手术治愈。1例颈侧区小切口组患者因病变旁腺异位行全身麻醉,其余颈侧区组患者均行颈丛麻醉。3组间在暂时性低钙血症方面差异无统计学意义(P>0.05),但颈侧区入路小切口组手术时间减少,住院时间缩短,伤口长度降低(P<0.05)。结论颈丛麻醉下颈侧区入路小切口甲状旁腺切除术治疗单发性甲状旁腺腺瘤效果确切,手术创伤小,并发症少,是一种安全有效的手术方式。Objective To investigate the safety and efficacy of focused parathyroidectomy that is performed through lateral cervical approach under the effect of regional anaesthesia.Methods We carried out a retrospective analysis of 250 patients with solitary parathyroid adenoma. 87 patients underwent conventional middle-access exploration,70 patients underwent modified Miccoli approach, while the remaining 93 patients underwent focused parathyroidectomy through lateral cervical approach. We recorded biochemical parameters of these patients at the preoperative and postoperative stages and during the follow-up period. We compared the operative times, hospital stays and morbidity rates of these patients.Results There was one case of relapse in CE group and FP group. All the other patients were cured by the primary operation. Cervical plexus block anaesthesia was administered to all patients except a patient with ectopical parathyroid gland. There was no significant difference in temporary hypocalcaemia of these patients postoperatively （P〉0.05）. Compared to CE group and modified Miccoli approach, focused approach was more advantageous, with shorter operative times, smaller scar lengths and shorter hospital stays （P〈0.05）.Conclusion Focused parathyroidectomy through lateral cervical approach can reach conventional surgical resection range and less complication rates.It is a safe and effective method in treating solitary parathyroid adenoma.

关 键 词：颈侧区入路 甲状旁腺切除术 颈丛麻醉 甲状旁腺腺瘤 原发性甲状旁腺功能亢进 

分 类 号：R6[医药卫生—外科学]