两种不同手术入路在甲状腺乳头状癌患者开放性根治性术中的应用比较  

Comparison of two different surgical approaches for open radical surgery in patients with papillary thyroid cancer

作　　者：顾雯 凌守鑫 唐海利 甘雪梅 Gu Wen;Ling Shouxin;Tang Haili;Gan Xuemei(Department of General Surgery,The Second Affiliated Hospital of Air Force Military Medical University,Xi'an Shaanxi Province 710038,China;Department of Anesthesia Operating Room,The Second Affiliated Hospital of Air Force Military Medical University,Xi'an Shaanxi Province 710038,China)

机构地区：[1]空军军医大学第二附属医院普外科,西安710038 [2]空军军医大学第二附属医院麻醉手术室,西安710038

出　　处：《中华普外科手术学杂志（电子版）》2024年第6期687-690,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：陕西省自然科学基础研究计划项目(2022JM-604)。

摘　　要：目的探究两种不同手术入路在甲状腺乳头状癌患者开放性根治性术中的应用效果差异。方法回顾性分析2019年1月至2023年1月收治的98例甲状腺乳头状癌患者的临床资料,根据患者手术方式分组,将行甲状腺内侧气管旁入路的患者纳入观察组(n=48例),行传统甲状腺外侧入路的患者纳入对照组(n=50例)。数据应用统计学软件SPSS 26.0处理,预后情况等计数资料以[例(%)]表示,采用χ^(2)检验;术中及术后情况等计量资料用(χ±s)表示,两组间采用独立样本t检验。P<0.05为差异具有统计学意义。结果观察组患者手术时间、术中出血量、术后拔管时间、术后住院时间均低于对照组,观察组患者颈部引流量高于对照组(P<0.05);术后30 d,两组患者PTH、Ca^(2+)水平均较术前下降,且观察组患者PTH、Ca^(2+)水平高于对照组(P<0.05);观察组患者低钙血症、暂时性甲状旁腺功能减退、暂时性喉返神经麻痹、喉返神经损伤发生率均低于对照组(P<0.05);两组患者术后1年存活率、复发率、远处转移情况比较,差异无统计学意义(P>0.05)。结论甲状腺内侧气管旁入路的开放性根治性手术更便捷,且能保护甲状腺乳头状癌患者喉返神经及甲状旁腺功能,造成不良影响更小。Objective To explore the difference of the application effect of two different surgical approaches in the open radical operation of patients with papillary thyroid cancer.Methods The clinical data of 98 patients with papillary thyroid carcinoma admitted from January 2019 to January 2023 were retrospectively analyzed.Patients were grouped according to the surgical method,and patients receiving medial paratRAC approach to thyroid gland were included in the observation group(n=48 cases),and patients receiving traditional lateral approach to thyroid gland were included in the control group(n=50 cases).Statistical software SPSS 26.0 was used to process the data.Statistical data such as prognosis were presented as[cases(%)]andχ^(2) test was used.Intraoperative and postoperative measurement data were expressed as(χ±s),and independent sample t test was used between the two groups.P<0.05 was considered statistically significant.Results The operative time,intraoperative blood loss,postoperative extubation time and postoperative hospital stay in observation group were lower than those in control group,and the neck drainage volume in observation group was higher than that in control group(P<0.05).30 days after surgery,PTH and Ca^(2+)levels in both groups decreased compared with those before surgery,and PTH and Ca^(2+)levels in observation group were higher than those in control group(P<0.05).The incidence of hypocalcemia,temporary hypoparathyroidism,temporary recurrent laryngeal nerve paralysis and recurrent laryngeal nerve injury in observation group were lower than those in control group(P<0.05).There was no significant difference in 1-year survival rate,recurrence rate and distant metastasis between the two groups(P>0.05).Conclusion Open radical surgery with medial paratransheal approach to thyroid gland is more convenient and can protect recurrent laryngeal nerve and parathyroid function in patients with papillary thyroid cancer with less adverse effects.

关 键 词：甲状腺肿瘤 癌 乳头状 甲状腺切除术 内侧气管旁入路 预后 

分 类 号：R736.1[医药卫生—肿瘤]