精细被膜解剖技术在分化型甲状腺癌手术中的应用
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摘要
目的观察精细被膜解剖技术在分化型甲状腺癌手术中的应用效果。方法回顾性分析2014年6月至2016年1月在新乡医学院第三附属医院普外科行甲状腺全切除术的147例分化型甲状腺癌患者的临床资料,根据手术方式分为观察组和对照组;观察组91例患者给予精细被膜解剖技术;对照组56例患者给予传统解剖方法。比较2组患者术中出血量、术后喉返神经及甲状旁腺损伤的发生率。结果观察组患者术中出血量(30.2±3.5)mL,对照组患者术中出血量(56.3±7.9)mL,观察组患者术中出血量少于对照组(P<0.05)。观察组患者暂时性喉返神经麻痹和暂时性甲状旁腺功能减退症发生率分别为1.10%和2.20%,对照组患者暂时性喉返神经麻痹和暂时性甲状旁腺功能减退症发生率分别为10.71%和12.50%,观察组患者暂时性喉返神经麻痹和暂时性甲状旁腺功能减退症发生率低于对照组(χ~2=5.106、4.735,P<0.05)。观察组患者永久性喉返神经损伤发生率(0.00%)和永久性甲状旁腺功能减退症发生率(0.00%)与对照组(1.79%、1.79%)比较差异均无统计学意义(χ~2=0.061、0.061,P>0.05)。结论分化型甲状腺癌患者行甲状腺全切手术中采用精细被膜解剖技术,能够减少术中出血量,并有效降低术后喉返神经、甲状旁腺损伤的发生率。
Objective To observe the effect of meticulous capsular dissection technique in the operation of differentiated thyroid cancer patients. Methods The data of 147 patients with differentiated thyroid carcinoma confirmed by pathology and treated with total thyroidectomy from General Surgery Department of the Third Affiliated Hospital of Xinxiang Medical University in June 2014 to January 2016 were analyzed retrospectively. The patients were divided into observation group( n = 91)and control group( n = 56) according to the different operation method. The patients in the observation group and control group were given meticulous capsular dissection technique and traditional dissection method,respectively. Intraoperative amount of bleeding,the injury rate of recurrent laryngeal nerve and parathyroid glands were compared between the two groups. Results The amount of bleeding in the observation group and the control group was( 30. 2 ± 3. 5) m L and( 56. 3 ± 7. 9) m L,respectively. The amount of bleeding in the observation group was less than that in the control group( P < 0. 05). The rate of recurrent laryngeal nerve paralysis( 1. 10%) and the rate of recurrent hypoparathyroidism( 2. 20%) in the observation group were lower than those in the control group( 10. 71%,12. 50%)( χ2= 5. 106,4. 735; P < 0. 05). The rate of permanent laryngeal nerve paralysis and the rate of permanent hypoparathyroidism in the observation group were 0. 00% and 0. 00%. The rate of permanent laryngeal nerve paralysisand the rate of permanent hypoparathyroidism in the control group were 1. 79% and 1. 79%. There was no significant difference in the rate of permanent laryngeal nerve paralysis and the rate of permanent hypoparathyroidism between the two groups( χ2= 0. 061,0. 061; P > 0. 05). Conclusion The application of meticulous capsular dissection technique in total thyroidectomy for differentiated thyroid cancer patients can reduce intraoperative amount of bleeding,and effectively reduce the incidence of postoperative injury rate of laryngeal nerve and parathyroid.
Objective To observe the effect of meticulous capsular dissection technique in the operation of differentiated thyroid cancer patients. Methods The data of 147 patients with differentiated thyroid carcinoma confirmed by pathology and treated with total thyroidectomy from General Surgery Department of the Third Affiliated Hospital of Xinxiang Medical University in June 2014 to January 2016 were analyzed retrospectively. The patients were divided into observation group( n = 91)and control group( n = 56) according to the different operation method. The patients in the observation group and control group were given meticulous capsular dissection technique and traditional dissection method,respectively. Intraoperative amount of bleeding,the injury rate of recurrent laryngeal nerve and parathyroid glands were compared between the two groups. Results The amount of bleeding in the observation group and the control group was( 30. 2 ± 3. 5) m L and( 56. 3 ± 7. 9) m L,respectively. The amount of bleeding in the observation group was less than that in the control group( P < 0. 05). The rate of recurrent laryngeal nerve paralysis( 1. 10%) and the rate of recurrent hypoparathyroidism( 2. 20%) in the observation group were lower than those in the control group( 10. 71%,12. 50%)( χ2= 5. 106,4. 735; P < 0. 05). The rate of permanent laryngeal nerve paralysis and the rate of permanent hypoparathyroidism in the observation group were 0. 00% and 0. 00%. The rate of permanent laryngeal nerve paralysisand the rate of permanent hypoparathyroidism in the control group were 1. 79% and 1. 79%. There was no significant difference in the rate of permanent laryngeal nerve paralysis and the rate of permanent hypoparathyroidism between the two groups( χ2= 0. 061,0. 061; P > 0. 05). Conclusion The application of meticulous capsular dissection technique in total thyroidectomy for differentiated thyroid cancer patients can reduce intraoperative amount of bleeding,and effectively reduce the incidence of postoperative injury rate of laryngeal nerve and parathyroid.
引文
[1]郭艳风,韩芳毅,周红艳,等.L型氨基酸转运体1和血管内皮生长因子在甲状腺乳头状癌中的表达及意义[J].新乡医学院学报,2017,34(1):36-38,42.
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[4]金善恩,卢仙球,周睿,等.精细化被膜解剖法在双侧甲状腺乳头状癌全切术中的应用:附25例报告[J].浙江临床医学,2013,15(12):1840-1842.
[5]GULCELIK M A,KURU B,DINCER H,et al.Complications of completion versus total thyroidectomy[J].Asian Pac J Cancer Prev,2012,13(10):5225-5228.
[6]王波,徐旭东,刘宁,等.腔镜甲状腺切除术中喉返神经的显露[J].中国微创外科杂志,2013,13(6):560-562.
[7]BLISS R D,GAUGER P G,DELBRIDGE L W.Surgeon's approach to the thyroid gland:surgical anatomy and importance of technique[J].World J Surg,2000,24(8):891-987.
[8]陈光,范志民.甲状腺、乳腺外科发展现状与展望[J].中华普通外科学文献:电子版,2010,4(6):515-517.DOI:10.3877/cma.j.issn.1674-0793.2010.06.002.
[9]SERPELL J W.New operative surgical concept of two fasciallayers enveloping the recurrent laryngeal nerve[J].Ann Surg Oncol,2010,17(6):1628-1636.
[10]梁建文,张有利,杨小静.甲状腺癌全切术中应用被膜解剖技术对甲状旁腺功能及喉返神经的影响[J].河南医学研究,2016,25(2):237-239.
[11]THOMPSON N W,OLSEN W R,HOFFMAN G L.The continuing development of the technique of thyroidectomy[J].Surgery,1973,73(6):913-927.
[12]高力,谢磊,叶学红,等.甲状腺全切除或近全切除术治疗180例甲状腺癌的手术体会[J].外科理论与实践,2003,8(4):300-303.
[13]闫利英,李随勤,张少强,等.甲状腺全切及近全切术中甲状旁腺的原位保护[J].临床耳鼻咽喉科杂志,2006,20(21):980-982.
[14]何文海.精细化被膜解剖技术在甲状腺手术中的应用效果[J].广西医学,2017,39(2):261-262,271.
[15]张海东,龚单春,刘亚群,等.甲状腺全切手术中甲状旁腺的保护[J].中华耳鼻咽喉头颈外科杂志,2014,49(11):889-892.
[16]CHAUHAN A,SERPELL J W.Thyroidectomy is safe and effective for retrosternal goiter[J].ANZ J Surg,2006,76(4):238-242.
[17]张勤修,叶静,李满.甲状腺手术中精细化被膜解剖法的应用[J].临床耳鼻咽喉科杂志,2005,19(12):552-553.
[2]田文,罗晋.中国与美国甲状腺结节与分化型甲状腺癌诊治指南比较[J].中国实用外科杂志,2013,33(6):475-479.
[3]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.
[4]金善恩,卢仙球,周睿,等.精细化被膜解剖法在双侧甲状腺乳头状癌全切术中的应用:附25例报告[J].浙江临床医学,2013,15(12):1840-1842.
[5]GULCELIK M A,KURU B,DINCER H,et al.Complications of completion versus total thyroidectomy[J].Asian Pac J Cancer Prev,2012,13(10):5225-5228.
[6]王波,徐旭东,刘宁,等.腔镜甲状腺切除术中喉返神经的显露[J].中国微创外科杂志,2013,13(6):560-562.
[7]BLISS R D,GAUGER P G,DELBRIDGE L W.Surgeon's approach to the thyroid gland:surgical anatomy and importance of technique[J].World J Surg,2000,24(8):891-987.
[8]陈光,范志民.甲状腺、乳腺外科发展现状与展望[J].中华普通外科学文献:电子版,2010,4(6):515-517.DOI:10.3877/cma.j.issn.1674-0793.2010.06.002.
[9]SERPELL J W.New operative surgical concept of two fasciallayers enveloping the recurrent laryngeal nerve[J].Ann Surg Oncol,2010,17(6):1628-1636.
[10]梁建文,张有利,杨小静.甲状腺癌全切术中应用被膜解剖技术对甲状旁腺功能及喉返神经的影响[J].河南医学研究,2016,25(2):237-239.
[11]THOMPSON N W,OLSEN W R,HOFFMAN G L.The continuing development of the technique of thyroidectomy[J].Surgery,1973,73(6):913-927.
[12]高力,谢磊,叶学红,等.甲状腺全切除或近全切除术治疗180例甲状腺癌的手术体会[J].外科理论与实践,2003,8(4):300-303.
[13]闫利英,李随勤,张少强,等.甲状腺全切及近全切术中甲状旁腺的原位保护[J].临床耳鼻咽喉科杂志,2006,20(21):980-982.
[14]何文海.精细化被膜解剖技术在甲状腺手术中的应用效果[J].广西医学,2017,39(2):261-262,271.
[15]张海东,龚单春,刘亚群,等.甲状腺全切手术中甲状旁腺的保护[J].中华耳鼻咽喉头颈外科杂志,2014,49(11):889-892.
[16]CHAUHAN A,SERPELL J W.Thyroidectomy is safe and effective for retrosternal goiter[J].ANZ J Surg,2006,76(4):238-242.
[17]张勤修,叶静,李满.甲状腺手术中精细化被膜解剖法的应用[J].临床耳鼻咽喉科杂志,2005,19(12):552-553.