分化型甲状腺癌甲状腺全切术中精细化甲状腺被膜解剖术与经环甲隙显露喉返神经法联合应用观察  

Combined application of refined thyroid membrane anatomy and exposure of recurrent laryngeal nerve in cricothyroid space in total thyroidectomy for differentiated thyroid cancer

作　　者：林庆军[1] 杜丽[1] 林燕晖 林燕纯 陈业晞[1] LIN Qingjun;DU Li;LIN Yanhui;LIN Yanchun;CHEN Yexi(Department of Thyroid Gland,Mammary Gland,Hernia Surgery,The Second Affiliated Hospital of Shantou University Medical College,Shantou 515041,China)

机构地区：[1]汕头大学医学院第二附属医院甲乳疝外科,广东汕头515041

出　　处：《山东医药》2023年第30期25-28,共4页Shandong Medical Journal

基　　金：汕头市科技计划项目(220517216492128)。

摘　　要：目的 观察分化型甲状腺癌(differentiated thyroid cancer,DTC)甲状腺全切术(total thyroidectomy,TT)中精细化甲状腺被膜解剖术与经环甲隙显露喉返神经法联合应用的效果。方法 110例DTC患者随机分为观察组和对照组各55例,观察组患者TT术中实施精细化甲状腺被膜解剖术联合环甲隙显露喉返神经法,对照组TT术中采用常规集束状结扎甲状腺腺叶后切除,记录两组手术时间、术中失血量及淋巴结清除数量,分别于术前及术后第1、3、7、28天时采集两组外周静脉血检测血清甲状旁腺功能指标甲状旁腺激素(parathyroid hormone,PTH)、钙离子(calci-um ion,Ca^(2+)),分别于术前、术后第6个月时采集两组外周静脉血检测骨代谢指标Ⅰ型前胶原氨基端前肽(procolla-gen typeⅠN-terminal propeptide,PINP)、β-胶原特殊序列(β-collagen specific sequence,β-CTX),随访6个月观察两组并发症、DTC复发情况。结果 两组患者手术时间、术中失血量及淋巴结清除数量比较,P均>0.05。与术前比较,术后第1、3、7、28天时两组血清PTH、Ca^(2+)水平均降低(P均<0.05);与对照组比较,术后第1、3、7、28天时观察组血清PTH、Ca^(2+)水平高(P均<0.05)。两组术前、术后6个月时血清PINP、β-CTX水平比较,P均>0.05。观察组、对照组并发症发生率分别为3.85%(2/52)、16.98%(9/53),二者比较,P<0.05。观察组和对照组复发例数分别为2、4例,二者比较,P>0.05。结论 精细化甲状腺被膜解剖术联合环甲隙显露喉返神经法在DTC患者TT中的应用效果较好,可降低患者术后血清PTH、Ca^(2+)水平,减少并发症的发生。Objective To observe the effect of refined thyroid membrane anatomy combined with exposure of recurrent laryngeal nerve in cricothyroid space in total thyroidectomy(TT)for differentiated thyroid cancer(DTC).Methods Totally 110 DTC patients were randomly divided into the observation group and the control group,with 55 cases in each group.Patients in the observation group underwent refined thyroid membrane anatomy combined with exposure of recurrent laryngeal nerve in cricothyroid space during TT operation,while patients in the control group underwent conventional cluster ligation of thyroid gland lobes before resection during TT operation.The operative time,intraoperative blood loss and number of lymph node removal in both groups were recorded.Peripheral venous blood was collected to determine the serum parathyroid function indicators[parathyroid hormone(PTH),calcium ion(Ca^(2+))]before surgery and on the 1st,3rd,7th,and 28th days after surgery,peripheral venous blood of the two groups was collected before surgery and 6 months after surgery to detect bone metabolism indexes[procollagen typeⅠN-terminal propeptide(PINP)andβ-collagen special sequence(β-CTX)],and complications and DTC recurrence in the two groups were observed at 6-month follow-up.Re⁃sults No significant differences were found in the operation time,intraoperative blood loss or lymph node removal between the two groups(all P>0.05).The serum PTH and Ca2+levels in both groups decreased on the 1st,3rd,7th,and 28th days after surgery in comparison with those before surgery(all P<0.05).Compared with the control group,the serum PTH and Ca^(2+) levels on the 1st,3rd,7th,and 28th days after surgery were higher in the observation group(all P<0.05).No significant differences were found in serum PINP orβ-CTX levels between the two groups before and 6 months after surgery(all P>0.05).The incidences of complications in the observation group and control group were 3.85%(2/52)and 16.98%(9/53)respectively,with statistically significant difference(P<0.05).The nu

关 键 词：甲状腺全切术 甲状腺被膜解剖术 喉返神经显露方法 环甲隙 甲状腺切除术并发症 甲状旁腺损伤 喉返神经损伤 

分 类 号：R653[医药卫生—外科学]