系膜分层解剖法与传统脱帽法在全甲状腺切除术中的应用效果对比  

Comparison of the layer dissection and traditional management of the superior pole thyroid capsule in total thyroidectomy

作　　者：朱杰高[1] 赵宁[1] 张忠涛[1] 滕长胜[1] Zhu Jiegao;Zhao Ning;Zhang Zhongtao;Teng Changsheng(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing,100050,China)

机构地区：[1]首都医科大学附属北京友谊医院普外科

出　　处：《国际外科学杂志》2021年第8期526-531,共6页International Journal of Surgery

基　　金：北京市医管局科研培育计划(PX2019004);北京市优秀人才培养资助青年骨干个人项目(2018000021469G197)。

摘　　要：目的:通过术后甲状旁腺素水平及血钙水平的比较,比较系膜分层解剖法与传统的脱帽法在全甲状腺切除术中应用效果的差异。方法:回顾性总结在2019年1月—2019年6月期间行全甲状腺切除手术患者,纳入分析患者120例,其中男性24例,女性96例,年龄24~72岁,中位年龄52岁。根据甲状腺上极系膜处理方法的不同进行分组,其中系膜分层组63例,传统脱帽组57例,主要观察指标为术后第1天甲状旁腺素水平及血钙水平。非正态分布的计量资料以四分位数M(P25,P75)描述,组间比较采用t检验或非参数检验;计数资料组间比较采用χ^(2)检验。结果:系膜分层组术后第1天血钙水平明显高于传统脱帽组[2.15 mmol/L(2.07 mmol/L,2.23 mmol/L)比2.10 mmol/L(2.01 mmol/L,2.18 mmol/L),Z=-2.019,P=0.043]。系膜分层组术后第1天甲状旁腺素水平也明显高于传统脱帽组[23.8 pg/mL(16.2 pg/mL,34.8 pg/mL)比15.3 pg/mL(8.9 pg/mL,29.0 pg/mL),Z=-3.646,P<0.001]。同时系膜分层组术后并发症发生率低于传统脱帽组(6.3%比21.1%,χ^(2)=5.599,P=0.018)。术后1个月患者复查血钙,系膜分层组和传统脱帽组分别为2.31 mmol/L(2.23 mmol/L,2.41 mmol/L)比2.32 mmol/L(2.26 mmol/L,2.37 mmol/L)(Z=-0.657,P=0.648),术后1个月甲状旁腺素水平分别为37.6 pg/mL(32.3 pg/mL,51.1 pg/mL)比35.8 pg/mL(27.7 pg/mL,48.9 pg/mL)(Z=-0.674,P=0.499),两组差异均无统计学意义。结论:全甲状腺切除术中,系膜分层解剖法处理甲状腺上极,较传统脱帽法能够减少术后低钙血症的发病率,减少术后并发症的发病率,提高患者的生活质量。Objective:To compare the effect of layer dissection and traditional management in total thyroidectomy by comparing the levels of parathyroid hormone and calcium after operation.Methods:From January 2019 to June 2019,a total of 120 patients who underwent total thyroidectomy were retrospectively analyzed,in including 96 females and 24 males,aged from 24 to 72 years old,with the average of 52 years.There were 63 cases in layer dissection group and 57 cases in traditional management group.The main index was the level of parathyroid hormone and blood calciumon the 1st day after operation.The measurement data of non normal distribution were described by quartile[M(P25,P75)].T-test or nonparametric test were used for comparison between groups.The chi-square was used to conduct comparison between count data of groups.Results:On the first day after operation,the serum calcium level in the layer dissection group was significantly higher than that in the traditional management group,with a median of 2.15 mmol/L and 2.10 mmol/L,respectively(Z=-2.019,P=0.043).The level of parathyroid hormone in layer dissection group was significantly higher than that in traditional management group[23.8(16.2~34.8)pg/mL vs 15.3(8.9~29.0)pg/mL,Z=-3.646,P<0.001].The incidence of postoperative complications in the layer dissection group was lower than that in the traditional management group(6.3%vs 21.1%,χ^(2)=5.599,P=0.018).One month after operation,the results of blood calcium and parathyroid hormone were both normal[blood calcium 2.31(2.23~2.41)mmol/L vs 2.32(2.26~2.37)mmol/L,Z=-0.657,P=0.648 and parathyroid hormone 37.6(32.3~51.1)pg/m vs 35.8(27.7~48.9)pg/mL,Z=-0.674,P=0.499],and there was no significant difference between the two groups.Conclusion:The layer dissection method for the superior pole thyroid capsule,compared with traditional management,can reduce the incidence rate of postoperative hypocalcemia and the incidence rate of postoperative complications,can improve the quality of patients′life.

关 键 词：甲状腺切除术 甲状旁腺 低钙血症 甲状旁腺功能低下 

分 类 号：R653[医药卫生—外科学]