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.pdf
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1、山东医药2023 年第 63 卷第 30 期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林庆军,杜丽,林燕晖,林燕纯,陈业晞汕头大学医学院第二附属医院甲乳疝外科,广东汕头515041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
2、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(calcium ion,Ca2+),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型前胶原氨基端前肽(procollagen type N-terminal propeptide,PINP)、-胶原特殊序列(-collagen specific sequence,-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
3、,P均0.05。与术前比较,术后第1、3、7、28天时两组血清PTH、Ca2+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、Ca2+水平高(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,P0.05。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、Ca2+水平,减少并发症的发生。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doi:10.3969/j.issn.1002-
4、266X.2023.30.006 中图分类号:R653 文献标志码:A 文章编号:1002-266X(2023)30-0025-04Combined application of refined thyroid membrane anatomy and exposure of recurrent laryngeal nerve in cricothyroid space in total thyroidectomy for differentiated thyroid cancerLIN Qingjun,DU Li,LIN Yanhui,LIN Yanchun,CHEN YexiDepartm
5、ent of Thyroid Gland,Mammary Gland,Hernia Surgery,The Second Affiliated Hospital of Shantou University Medical College,Shantou 515041,ChinaAbstract:Objective To observe the effect of refined thyroid membrane anatomy combined with exposure of recurrent laryngeal nerve in cricothyroid space in total t
6、hyroidectomy(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
7、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
8、.Peripheral venous blood was collected to determine the serum parathyroid function indicators parathyroid hormone(PTH),calcium ion(Ca2+)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
9、to detect bone metabolism indexes procollagen type N-terminal propeptide(PINP)and-collagen special sequence(-CTX),and complications and DTC recurrence in the two groups were observed at 6-month follow-up.Results No significant differences were found in the operation time,intraoperative blood loss or
10、 lymph node removal between the two groups(all P0.05).The serum PTH and Ca2+levels in both groups decreased on the 1st,3rd,7th,and 基金项目:汕头市科技计划项目(220517216492128)。第一作者简介:林庆军(1981-),男,硕士,主治医师,主要研究方向为甲乳疝外科疾病。E-mail:开放科学(资源服务)标识码(OSID)25山东医药2023 年第 63 卷第 30 期28th days after surgery in comparison with t
11、hose before surgery(all P0.05).Compared with the control group,the serum PTH and Ca2+levels on the 1st,3rd,7th,and 28th days after surgery were higher in the observation group(all P0.05).The incidences of complications in the observation group and control group were 3.85%(2/52)and 16.98%(9/53)respec
12、tively,with statistically significant difference(P0.05).Conclusion The application of refined thyroid membrane anatomy combined with exposure of recurrent laryngeal nerve in cricothyroid space in TT for patients with DTC is better,which can reduce the level of serum PTH and Ca2+and reduce the incide
13、nce of complications.Key words:total thyroidectomy;thyroid membrane anatomy;exposure of recurrent laryngeal nerve;cricothyroid space;complications of thyroidectomy;parathyroid gland injury;recurrent laryngeal nerve injury分化型甲状腺癌(differentiated thyroid cancer,DTC)是最常见的甲状腺癌类型,主要包括甲状腺乳头状癌和甲状腺滤泡状癌。发病人数增
14、加、早期患者比例增加及甲状腺乳头状癌构成比上升已成为目前我国DTC临床流行病学的三大特征1。甲状腺全切术(total thyroidectomy,TT)是目前最有效的 DTC治疗方法,患者 5 年存活率为 88%93%2。常规TT术中集束状结扎甲状腺腺叶后切除操作可能会导致患者喉返神经、甲状旁腺受损3。故优化手术操作方法,减少 TT并发症的发生是目前的研究热点。精细化甲状腺被膜解剖术在术中不结扎甲状腺下动脉主干,在甲状腺腹侧背膜区紧贴甲状腺真被膜进行超微化的解剖分离,以此减少术中操作对甲状旁腺的损伤,减少术后并发症的发生4。环甲隙显露喉返神经法是一种显露喉返神经的有效方法,喉返神经入喉部位固定
15、,处于环状软骨下端且位置浅,以环甲隙和环状软骨为标志,和既往以甲状腺下动脉为标志的显露法相比,更易定位喉返神经,并减轻神经损伤5。精细化甲状腺被膜解剖术联合环甲隙显露喉返神经法在TT术中的应用效果如何,目前相关研究较少。2020年 410月,本研究观察了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,现将结果报告如下。1 资料与方法 1.1临床资料选择2020年410月汕头大学医学院第二附属医院收治的DTC患者110例。纳入标准:经病理活检确诊为DTC6;符合TT适应证;年龄1875岁;近6个月无手术史;患者在知悉研究事项后同意参与。排除标准:合并甲状腺炎、甲亢
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- 分化 甲状腺癌 甲状腺 全切术中 精细 解剖 经环甲隙 显露 神经 联合 应用 观察