“1+x+1”策略在甲状腺乳头状癌行甲状腺全切联合中央区淋巴结清扫的临床应用  

The Clinical Application of"1+x+1"Strategy in Papillary Thyroid Carcinoma with Total Thyroidectomy Combined with Central Lymph Node Dissection

作　　者：王乐声 洪建明 陈培臻 蔡明勇 林永信 李颖 WANG Lesheng;HONG Jianming;CHEN Peizhen;CAI Mingyong;LIN Yongxin;LI Ying(Department of Thyroid Surgery,Zhangzhou Hospital,Fujian Medical University,Zhangzhou,Fujian Province,363000 China)

机构地区：[1]福建医科大学附属漳州市医院甲状腺外科,福建漳州363000

出　　处：《中外医疗》2021年第22期15-18,22,共5页China & Foreign Medical Treatment

摘　　要：目的探讨在甲状腺乳头状癌患者行甲状腺全部切除联合一侧或双侧中央区淋巴结清扫中应用“1+x+1”策略能否降低术后发生甲状旁腺功能减退的几率。方法回顾性分析福建医科大学附属漳州市医院2013年1月—2019年6月期间诊断甲状腺乳头状癌,并在同一手术团队行甲状腺全部切除联合一侧或双侧中央区淋巴结清扫患者的临床资料,根据有无应用“1+x+1”策略分为观察组和对照组,其中观察组268例,对照组244例,比较两组患者一般情况、术前血清钙、甲状旁腺激素水平、手术方式(全切+一侧/双侧中央区清扫)、术中出血量,手术时间和术后血清钙、甲状旁腺激素水平、中央区淋巴结清扫数目,喉返神经损伤情况。结果两组手术时间差异无统计学意义(P>0.05);观察组术中出血量低于对照组[(12.01±4.93)mL vs(14.90±5.95)mL],差异有统计学意义(t=-6.004,P<0.001);观察组中央区淋巴结清扫总数(9.34±4.95)个明显高于对照组(7.52±5.29)个,差异有统计学意义(t=4.022,P<0.001);观察组术后第1天、1个月、6个月ipth均明显高于对照组[(12.25±7.50)pg/mL vs(8.49±7.42)pg/mL,(15.31±5.23)pg/mL vs(11.24±6.38)pg/mL,(15.95±4.92)pg/mL vs(12.20±4.82)pg/mL],差异有统计学意义(t=5.694、7.922、8.698,P<0.05)。观察组术后第1天、1个月、6个月血清Ca2+均明显高于对照组[(2.12±0.12)mmol/L vs(2.03±0.15)mmol/L,(2.24±0.15)mmol/L vs(2.18±0.14)mmol/L,(2.27±0.14)mmol/L vs(2.20±0.14)mmol/L],差异有统计学意义(t=7.527、4.666、5.651,P<0.05)。观察组术后暂时性和永久性甲状旁腺功能减退发生率均明显低于对照组(30.90%vs 51.60%,0.37%vs 3.28%),差异有统计学意义(χ^(2)=22.587、4.675,P<0.05)。观察组术后喉返神经损伤的发生率低于对照组(1.12%vs 4.10%),差异有统计学意义(χ^(2)=4.580,P<0.05)。结论在甲状腺手术中应用“1+x+1”策略能够很好地保护术后甲状旁腺功能,减少并发症,提高淋巴结清�Objective To investigate whether the application of"1+x+1"strategy in patients with papillary thyroid carcinoma undergoing total thyroidectomy combined with one or both central lymph node dissection can reduce the chance of hypoparathyroidism after surgery.Methods A retrospective analysis of the clinical data of patients with papillary thyroid carcinoma diagnosed in Zhangzhou Hospital of Fujian Medical University from January 2013 to June 2019,and who underwent total thyroidectomy combined with one or both central lymph node dissections on the same surgical team according to whether the"1+x+1"strategy was applied or not,they were divided into observation group and control group.Among them,there were 268 cases in observation group and 244 cases in control group.Operation method(total resection+one/bilateral central area dissection),intraoperative blood loss,operation time and postoperative serum calcium,parathyroid hormone levels,the number of central area lymph nodes dissected,and recurrent laryngeal nerve injury.Results There was no significant difference in operation time between the two groups(P>0.05).The intraoperative blood loss in the observation group was lower than that in the control group[(12.01±4.93)mL vs(14.90±5.95)mL],and the difference was statist-ically significant(t=-6.004,P<0.001),the total number of lymph node dissections in the central area of the observation group(9.34±4.95)was significantly higher than that of the control group(7.52±5.29),the difference was statistically significant(t=4.022,P<0.001).The ipth of the observation group was significantly higher than that of the control group on the first day,one month,and six months after surgery[(12.25±7.50)pg/mL vs(8.49±7.42)pg/mL,(15.31±5.23)pg/mL vs(11.24±6.38)pg/mL,(15.95±4.92)pg/mL vs(12.20±4.82)pg/mL],the difference was statistically significant(t=5.694,7.922,8.698,P<0.05).Serum Ca2+in the observation group was significantly higher than that in the control group on the first day,one month,and six months after surgery[(2.12±0.12)

关 键 词：甲状腺乳头状癌 1+x+1策略 甲状旁腺功能减退 

分 类 号：R4[医药卫生—临床医学]