中间下入路途径在甲状腺癌切除术中的应用效果
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摘要
目的探讨中间下入路途径在甲状腺癌切除术中的应用效果。方法回顾性分析122例行甲状腺癌切除术治疗的甲状腺癌患者的临床资料。对照组(n=60)采用传统上入路途径进行手术,观察组(n=62)采用中间下入路途径进行手术。比较两组患者手术时间、术中出血量、术后第3天血清钙浓度及甲状旁腺激素水平。术后随访6个月,观察两组患者术后暂时性低钙血症、喉神经损伤及持久性低钙血症发生率。结果两组患者手术时间及术中出血量比较,差异均无统计学意义(均P>0.05);观察组术后第3天血清钙浓度及甲状旁腺激素水平均高于对照组(均P<0.05)。两组喉返神经损伤、喉上神经损伤及持续性低钙血症发生率比较,差异均无统计学意义(均P>0.05),而观察组暂时性低钙血症发生率低于对照组(P<0.05)。结论相比于传统术式,中间下入路途径甲状腺癌切除术术后患者血清钙浓度及甲状旁腺激素水平更高,暂时性低钙血症的发生率更低。
Objective To explore the effect of medium-inferior approach applied to thyroidectomy for thyroid cancer. Methods The clinical data of 122 patients with thyroid cancer who underwent thyroidectomy were retrospectively analyzed. The control group(n=60) applied conventional upper approach to the surgery,while the observation group(n=62) used medium-inferior approach. Operation duration,intraoperative blood loss,and serum calcium concentration and parathyroid hormone level on the third day after operation were compared between the two groups. During a 6-month follow-up postoperatively,incidence rates of postoperative temporary hypocalcemia,laryngeal nerve injury and persistent hypocalcemia were observed in both groups. Results There was no statistically significant difference in operation duration or intraoperative blood loss between the two groups(all P>0.05); the serum calcium concentration and parathyroid hormone level in the observation group were higher than those in the control group on the third day after operation(all P<0.05). No statistically significant difference was observed in incidence rate of recurrent laryngeal nerve injury,superior laryngeal nerve injury or persistent hypocalcemia between the two groups(all P>0.05),furthermore,the observation group had a lower incidence rate of temporary hypocalcemia than the control group(P<0.05). Conclusion Compared with conventional procedure,patients undergoing thyroidectomy via medium-inferior approach experience higher postoperative serum calcium concentration and parathyroid hormone level as well as a lower incidence rate of temporary hypocalcemia.
Objective To explore the effect of medium-inferior approach applied to thyroidectomy for thyroid cancer. Methods The clinical data of 122 patients with thyroid cancer who underwent thyroidectomy were retrospectively analyzed. The control group(n=60) applied conventional upper approach to the surgery,while the observation group(n=62) used medium-inferior approach. Operation duration,intraoperative blood loss,and serum calcium concentration and parathyroid hormone level on the third day after operation were compared between the two groups. During a 6-month follow-up postoperatively,incidence rates of postoperative temporary hypocalcemia,laryngeal nerve injury and persistent hypocalcemia were observed in both groups. Results There was no statistically significant difference in operation duration or intraoperative blood loss between the two groups(all P>0.05); the serum calcium concentration and parathyroid hormone level in the observation group were higher than those in the control group on the third day after operation(all P<0.05). No statistically significant difference was observed in incidence rate of recurrent laryngeal nerve injury,superior laryngeal nerve injury or persistent hypocalcemia between the two groups(all P>0.05),furthermore,the observation group had a lower incidence rate of temporary hypocalcemia than the control group(P<0.05). Conclusion Compared with conventional procedure,patients undergoing thyroidectomy via medium-inferior approach experience higher postoperative serum calcium concentration and parathyroid hormone level as well as a lower incidence rate of temporary hypocalcemia.
引文
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[2]曹苏生.甲状腺癌手术中副损伤的控制问题[J].中国肿瘤外科杂志,2017,9(4):219-221,245.
[3]韦伟,李朋.甲状腺癌颈淋巴结清扫术常见并发症及其防治[J].中国实用外科杂志,2017,37(9):970-973.
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[5]中华医学会内分泌学分会,中华医学会外科学分会,中国抗癌协会头颈肿瘤专业委员会,等.甲状腺结节和分化型甲状腺癌诊治指南[J].中国肿瘤临床,2012,39(17):1 249-1 272.
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[7]田文.应重视甲状腺全切除术中并发症的预防[J].中华外科杂志,2015,53(3):161-163.
[8]孙辉,刘晓莉.甲状腺癌规范化诊治理念更新及其意义[J].中国实用外科杂志,2015,35(1):72-75.
[9]Wang K,Cai H,Kong D,et al.The identification,preservation and classification of the external branch of the superior laryngeal nerve in thyroidectomy[J].World J Surg,2017,41(10):2 521-2 529.
[10]田成龙,袁宏伟,谢勇,等.不显露喉上神经的甲状腺切除术对患者术后高音功能的影响[J].中华普通外科杂志,2017,32(6):529.
[11]Bliss RD,Gauger PG,Delbridge LW.Surgeon's approach to the thyroid gland:surgical anatomy and the importance of technique[J].World J Surg,2000,24(8):891-897.
[12]王占龙,宋晓飞,吴干勋,等.喉上神经外支在环甲间隙的应用解剖学研究[J].中国临床解剖学杂志,2014,32(6):633-636.
[13]宋琦,李晓明.甲状腺手术中甲状旁腺和喉神经功能损伤的防治策略[J].中国肿瘤临床,2017,44(9):409-414.
[14]余炯标,区奕猛,罗永平,等.逆行切除法在甲状腺腺叶全切除术的应用[J].中华普通外科学文献(电子版),2017,11(1):48-50.
[15]Seven H,Calis AB,Vural C,et al.Microscopic thyroidectomy:a prospective controlled trial[J].Eur Arch Otorhinolaryngol,2005,262(1):41-44.
[16]张军,高明.神经监测技术在甲状腺手术中帮助识别喉上神经外支的临床意义[J].中国肿瘤临床,2018,45(4):201-204.
[17]Mangano A,Lianos GD,Boni L,et al.Intraoperative neuromonitoring of the external branch of the superior laryngeal nerve during thyroidectomy:the need for evidence-based data and perioperative technical/technological standardization[J].Sci World J,2014:692 365.
[2]曹苏生.甲状腺癌手术中副损伤的控制问题[J].中国肿瘤外科杂志,2017,9(4):219-221,245.
[3]韦伟,李朋.甲状腺癌颈淋巴结清扫术常见并发症及其防治[J].中国实用外科杂志,2017,37(9):970-973.
[4]汤治平,梁志宏,赵象文,等.甲状腺韧带解剖的再认识以及甲状腺手术新路径的研究[J].中华普通外科学文献(电子版),2009,3(2):136-138.
[5]中华医学会内分泌学分会,中华医学会外科学分会,中国抗癌协会头颈肿瘤专业委员会,等.甲状腺结节和分化型甲状腺癌诊治指南[J].中国肿瘤临床,2012,39(17):1 249-1 272.
[6]廖泉.甲状腺外科手术中甲状旁腺功能保护[J].中国实用外科杂志,2015,35(6):672-673.
[7]田文.应重视甲状腺全切除术中并发症的预防[J].中华外科杂志,2015,53(3):161-163.
[8]孙辉,刘晓莉.甲状腺癌规范化诊治理念更新及其意义[J].中国实用外科杂志,2015,35(1):72-75.
[9]Wang K,Cai H,Kong D,et al.The identification,preservation and classification of the external branch of the superior laryngeal nerve in thyroidectomy[J].World J Surg,2017,41(10):2 521-2 529.
[10]田成龙,袁宏伟,谢勇,等.不显露喉上神经的甲状腺切除术对患者术后高音功能的影响[J].中华普通外科杂志,2017,32(6):529.
[11]Bliss RD,Gauger PG,Delbridge LW.Surgeon's approach to the thyroid gland:surgical anatomy and the importance of technique[J].World J Surg,2000,24(8):891-897.
[12]王占龙,宋晓飞,吴干勋,等.喉上神经外支在环甲间隙的应用解剖学研究[J].中国临床解剖学杂志,2014,32(6):633-636.
[13]宋琦,李晓明.甲状腺手术中甲状旁腺和喉神经功能损伤的防治策略[J].中国肿瘤临床,2017,44(9):409-414.
[14]余炯标,区奕猛,罗永平,等.逆行切除法在甲状腺腺叶全切除术的应用[J].中华普通外科学文献(电子版),2017,11(1):48-50.
[15]Seven H,Calis AB,Vural C,et al.Microscopic thyroidectomy:a prospective controlled trial[J].Eur Arch Otorhinolaryngol,2005,262(1):41-44.
[16]张军,高明.神经监测技术在甲状腺手术中帮助识别喉上神经外支的临床意义[J].中国肿瘤临床,2018,45(4):201-204.
[17]Mangano A,Lianos GD,Boni L,et al.Intraoperative neuromonitoring of the external branch of the superior laryngeal nerve during thyroidectomy:the need for evidence-based data and perioperative technical/technological standardization[J].Sci World J,2014:692 365.