经胸乳入路腔镜甲状腺癌根治术对患者甲状旁腺功能的影响

Effect of endoscopic radical thyroidectomy via a chest-breast approach on parathyroid function of patients with thyroid cancer

目的探讨经胸乳入路腔镜甲状腺癌根治术对患者甲状旁腺功能的影响。方法抽取2018年6月至2020年6月河南中医药大学第一附属医院收治的100例甲状腺微小癌患者为研究对象,根据术式分为腔镜组和开放组,每组50例。比较两组患者围术期相关指标、手术前后血清甲状旁腺素水平和血钙值、术后并发症发生情况。结果腔镜组手术时间长于开放组(P<0.05),术中出血量、术后引流管拔管时间、术后1 d的视觉模拟评分法评分及住院时间均少于开放组(P均<0.01)。两组清扫淋巴结数量比较差异未见统计学意义(P>0.05)。术后第1、3天,两组患者血清甲状旁腺素水平、血钙值均显著下降,但腔镜组患者血清甲状旁腺素值、血钙值均高于开放组,差异有统计学意义(P<0.05)。腔镜组患者低甲状旁腺素、低血钙及症状性低血钙发生率(6.00%,3/50;8.00%,4/50;6.00%,3/50)均低于开放组(20.00%,10/50;24.00%,12/50;22.00%,11/50),P均<0.05。腔镜组术后并发症发生率低于对照组(P<0.05)。结论经胸乳入路腔镜甲状腺癌根治术能够更好地保护患者的甲状旁腺功能,降低术后并发症发生率。

Objective To investigate the effect of endoscopic radical thyroidectomy via a chest-breast approach on parathyroid function in patients with thyroid cancer.Methods A total of 100 patients with thyroid microcarcinoma admitted to the First Affiliated Hospital of Henan University of Chinese Medicine from June 2018 to June 2020 were selected as the study objects.They were divided into endoscopic group and open group according to the operation method,with 50 cases in each group.Perioperative indexes,preoperative and postoperative level of serm parathyroid hormone and blood calcium,and postoperative complications were compared between the two groups.Results The operation time in the endoscopic group was longer than that in the open group(P<0.05),and intraoperative blood loss,postoperative drainage tube extubation time,the visual analogue scale score 1 day after operation,and hospital stay in the endoscopic group were less than those in the open group(all P<0.01).There was no significant difference in the number of dissected lymph node between the two groups(P>0.05).The levels of serum parathyroid hormone and blood calcium in two groups significantly decreased,but the two indicators of the endoscopic group were significantly higher than those of the open group 1 and 3 days after surgery(P<0.05).The incidence of parathyroid hormone decreasing,hypocalcium and symptomatic hypocalcium in the endoscopic group(6.00%,3/50;8.00%,4/50;6.00%,3/50)were lower than those in the open group(20.00%,10/50;24.00%,12/50;22.00%,11/50),all P<0.05.The incidence of postoperative complications in the endoscopic group was lower than that in the open group(P<0.05).Conclusions Endoscopic radical thyroidectomy via a chest-breast approach can protect the parathyroid function of patients with thyroid cancer,with low postoperative complication rate.