改良Miccoli术式甲状腺腺叶切除术中运用膜解剖技术的出血控制探讨  

Discussion on hemorrhage control in membrane dissection technique of modified Miccoli thyroid lobectomy

作　　者：杨涛 张宇 梅静 李敏娟 彭柳 汤鹏飞 侯东旭 YANG Tao;ZHANG Yu;MEI Jing;LI Minjuan;PENG Liu;TANG Pengfei;HOU Dongxu(Department of Thyroid Surgery,Zhuzhou 331 Hospital,Zhuzhou 412000,China)

机构地区：[1]株洲市三三一医院甲状腺外科,湖南株洲412002

出　　处：《山东医药》2025年第3期106-110,共5页Shandong Medical Journal

基　　金：湖南省创新引导计划临床医疗技术创新引导项目(2018SK52703)。

摘　　要：目的分析改良Miccoli术式甲状腺腺叶切除术中运用膜解剖技术的出血量及出血部位对患者手术时间及术后并发症的影响。方法选择运用膜解剖技术完成改良MIiccoli术式单侧甲状腺腺叶加峡部切除加中央区淋巴结清扫术(CLND)的单侧甲状腺乳头癌患者125例,采用脑棉片浸染实验估算术中出血量(分为术中出血量<1.0 mL或≥1.0 mL者),术中出血量≥1.0 mL者再根据出血部位发生率分为危险区出血和非危险区出血,比较其手术时间和术后并发症(暂时性喉返神经损伤、生化型甲状旁腺功能减退)。结果125例患者中术中出血量<1.0 mL 84例(67.2%)、出血量≥1.0 mL 41例(32.8%),其手术时间分别为(59.8±4.9)、(81.1±8.2)min,二者比较P<0.05;其术后发生暂时性喉返神经损伤分别为2例(2.4%)、6例(14.6%),二者比较P<0.05;其术后发生生化型甲状旁腺功能减退分别为14例(16.7%)、8例(19.5%),二者比较P>0.05。术中出血量≥1.0 mL者危险区出血36例、非危险区出血5例,其手术时间分别为(82.1±8.3)、(73.9±1.7)min(P<0.05),其术后暂时性喉返神经损伤、生化型甲状旁腺功能减退发生率比较P均>0.05。结论膜解剖技术用于单侧甲状腺乳头癌患者改良Miccoli术式甲状腺腺叶切除术,术中出血量控制在1.0 mL以内并避免危险区出血可以缩短手术时间、减少术后并发症的发生。Objective To analyze the impact of bleeding volume and bleeding sites on operative time and postoperative complications during the dissection of the membrane in the modified Miccoli technique for thyroid lobectomy.Methods A total of 125 patients with unilateral papillary thyroid carcinoma underwent a modified Miccoli procedure involving unilateral lobectomy,isthmectomy,and central lymph node dissection(CLND)using the membrane dissection technique.A"brain cotton piece immersion experiment"was used to estimate intraoperative blood loss(<1.0 mL or≥1.0 mL).Patients with intraoperative blood loss≥1.0 mL were further categorized into dangerous zone bleeding and non-dangerous zone bleeding based on bleeding sites.Operative time and postoperative complications(temporary recurrent laryngeal nerve injury and biochemical hypoparathyroidism)were compared.Results Among 125 patients,84(67.2%)had intraoperative blood loss<1.0 mL,and 41(32.8%)had≥1.0 mL;the operation time was(59.8±4.9)minutes for the<1.0 mL group and(81.1±8.2)minutes for the≥1.0 mL group(P<0.05);the incidence of temporary recurrent laryngeal nerve injury was 2.4%(2/84)and 14.6%(6/41),respectively(P<0.05);biochemical hypoparathyroidism occurred in 14(16.7%)and 8(19.5%)cases,respectively,with no significant difference between these two groups(P>0.05).Among patients with intraoperative blood loss≥1.0 mL,36 had bleeding in the dangerous zone and 5 had bleeding in the non-dangerous zone,with mean operation time of(82.1±8.3)and(73.9±1.7)minutes,respectively(P<0.05).There was no significant difference in the incidence of temporary recurrent laryngeal nerve injury and biochemical hypoparathyroidism between these groups(P>0.05).Conclusion The membrane dissection technique in modified Miccoli thyroid lobectomy for unilateral papillary thyroid carcinoma can control intraoperative blood loss within 1.0 mL,avoid bleeding in the dangerous zone,shorten operation time,and reduce postoperative complications.

关 键 词：膜解剖 改良Miccoli术式 甲状腺腺叶切除术 术中出血量 出血部位 手术时间 手术并发症 

分 类 号：R739.91[医药卫生—肿瘤]