囊内结扎甲状腺动脉分支在甲状腺手术后的功能保全的作用

Effect of Terminal Ligature of Thyroid Artery Branches on Preservation of Thyroid Function After Capsular Subtotal Thyroidectomy

目的探讨甲状腺次全切除术中甲状腺动脉分支结扎对减少喉返神经和甲状旁腺损伤的作用。方法 回顾性分析某医院1983-2009年487例甲状腺次全切除患者,其中352例囊内结扎甲状腺动脉分支,135例行甲状腺动脉主干结扎,采用χ2检验进行统计学分析,比较两者术后喉返神经和甲状旁腺损伤的发生率的差异。结果囊内甲状腺动脉分支结扎术后暂时性喉返神经损伤1.42%(5/352),永久性喉返神经损伤0.56%(2/352);术后暂时性甲状旁腺损伤2.27%(8/352)。永久性甲状旁腺功能低下0.56%(2/352);甲状腺动脉主干结扎术后喉返神经暂时性损伤6.67%(9/135),永久性损伤4.44%(6/135),术后暂时性甲状旁腺损伤8.14%(11/135),永久性甲状旁腺损伤2.22%(3/135)。甲状腺动脉分支结扎与主干结扎的喉返神经损伤率差异有统计学意义(P<0.01);两组甲状旁腺损伤率差异有统计学意义(P<0.01)。结论甲状腺次全切除术中行囊内分离结扎甲状腺下动脉分支结扎术可减少喉返神经和甲状旁腺功能损伤几率。

Objective To study whether terminal ligature of thyroid artery branches（TLTAB） during capsular subtotal thyroidectomy is associated with lower injury of recurrent laryngeal nerve（RLN） and parathyroid. Methods Altogether 487 patients underwent subtotal thyroidectomy in Renci Hospital of Guanyun County from 1983 to 2009 were retrospectively analyzed,including 352 cases with TLTAB and 135 cases with terminal ligature of thyroid artery trunk（TLTAT）.Chi square test was used to analyze the statistical differences between the two groups. Results Temporary RLN injury occurred in 1.42%（5/352）of TLTAB and 6.67%（9/135） of TLTAT.Permanent RLN injury occurred in 0.56%（2/352）of TLTAB and 4.44%（6/135）of TLTAT.Temporary hypoparathyroidism occurred in 2.27%（8/352） of TLTAB and 8.14%（11/135） of TLTAT.Permanent hypoparathyroidism occurred in 0.56%（2/352） of TLTAB and 2.22%（3/135） of TLTAT.There were statistically significant differences in the incidence rates of RLN injury and hypoparathyroidism between TLTAT and TLTAB（P0.01,P0.01）. Conclusions The approach of TLTAT during capsular subtotal thyroidectomy can reduce the probability of recurrent laryngeal nerve and parathyroid trauma.