无充气腋窝入路腔镜手术结合神经探测技术对甲状腺上极周围结构和功能保护的研究  

Study on the protection of the structure and function around the upper pole of thyroid gland by endoscopic surgery combined with nerve detection through the gasless axillary approach

作　　者：郭海巍 徐加杰 葛明华 郑传铭 GUO Haiwei;XU Jiajie;GE Minghua;ZHENG Chuanming(Department of Head and Neck Surgery,Center of Otolaryngology-head and Neck Surgery,Zhejiang Provincial People’s Hospital(People’s Hospital of Hangzhou Medical College),Key Laboratory of Endocrine Gland Diseases of Zhejiang Province,Hangzhou 310014,P.R.China)

机构地区：[1]浙江省人民医院(杭州医学院附属人民医院)头颈外科、耳鼻咽喉-头颈外科中心,浙江省内分泌腺体疾病诊治研究重点实验室,杭州310014

出　　处：《中国普外基础与临床杂志》2023年第2期142-147,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：浙江省医药卫生科技项目(项目编号:2020KY030)。

摘　　要：目的探索无充气腋窝入路腔镜甲状腺手术结合神经探测技术对于甲状腺上极周围结构和功能的保护效果。方法回顾性收集2019年1月至2020年6月期间在浙江省人民医院头颈外科行无充气腋窝入路腔镜甲状腺手术结合神经探测技术的48例患者作为腔镜组,53例接受开放甲状腺手术结合神经探测技术的患者作为开放组,比较2组患者的甲状腺上极周围结构和功能相关指标。结果在手术时间方面,腔镜组比开放组时间长(67.5 min vs.54.1 min,P=0.001),两组在术后住院时间及出血量方面的差异无统计学意义(P>0.05)。腔镜组中有47例有效探测并发现喉上神经(47/48,97.9%),与开放组(40/53,75.5%)相比较高(P=0.003),且腔镜组的舌下神经降支显露率也较高[31.3%(15/48)比3.8%(2/53),P=0.001]。腔镜组术中上极甲状旁腺均原位保留,术后无声音改变及饮水呛咳;开放组有2例行上极甲状旁腺自体移植,2例存在声音改变,且1例切开上极部分带状肌。2组的上极喉上神经损伤发生率、上极甲状旁腺自体移植率和颈前带状肌损伤率比较差异均无统计学意义(P>0.05)。2组患者手术前后的PTH和血钙水平的差值比较差异均无统计学意义(P>0.05)。结论在无充气腋窝入路腔镜甲状腺手术过程中结合神经探测技术,于甲状腺上极内侧环甲肌表面探查并保护喉上神经,利用精细化被膜解剖技术原位保护上极甲状旁腺,可更有效地显露喉上神经外支,有利于上极周围结构的保护。Objective To explore the protection of the structure and function around the upper pole of the thyroid gland by endoscopic thyroidectomy combined with nerve detection through the gasless unilateral axillary approach.Methods From January 2019 to June 2020,48 thyroid patients who underwent the gasless unilateral axillary approach combined with the endoscopy and nerve detection technology in the Department of Head and Neck Surgery of Zhejiang Provincial People’s Hospital were reviewed as the endoscopic group,and 53 thyroid patients underwent open surgery combined with the endoscopy and nerve detection technology as the open group.The protection of the functional structure of the suprathyroid pole were compared.Results In terms of operation time,the endoscopic group was longer than that of the open group(67.5 min vs.54.1 min,P=0.001).There was no statistical difference between the two groups in terms of postoperative hospital stay and blood loss(P>0.05).Forty-seven patients with the endoscopic thyroid surgery through the gasless unilateral axillary approach effectively detected the superior laryngeal nerve(47/48,97.9%),which was higher than that of the open group(40/53,75.5%),P=0.003,and the exposure rate of hypoglossal nerve descending branch in the endoscopic group was also higher[31.3%(15/48)vs.3.8%(2/53),P=0.001].In the endoscopic group,the superior parathyroid gland was kept in situ during the operation,and there was no change of voice and cough after the operation.In the open group,there were 2 cases of autologous transplantation of the upper pole parathyroid gland,2 patients had voice changes,and 1 case had partial upper pole banded muscle incision.There was no significant difference in the incidence of nerve injury complications,the rate of autologous transplantation of the upper pole parathyroid gland and the rate of anterior cervical banded muscle injury between the two groups(P>0.05).In addition,there was no significant difference in the levels of parathyroid hormone,blood calcium,blood magnesium and blo

关 键 词：甲状腺切除术 腔镜 腋窝入路 喉上神经 甲状旁腺 

分 类 号：R653[医药卫生—外科学]