甲状腺被膜内次全切除术近期并发症临床分析

Clinical analysis of short-term complications of membrane subtotal thyroid resection

目的探讨甲状腺被膜内次全切除术近期并发症的发生情况。方法选取2012年9月-2014年9月在广东东莞市人民医院接受治疗的甲状腺疾病患者84例。将其随机分为两组，观察组42例患者采用甲状腺被膜内次全切除术．对照组42例患者实施被膜外次全切除术。记录并比较两组患者手术时间、术中出血量、镇痛剂使用量及住院时间；比较两组患者术后7d内甲状旁腺功能减退、低钙血症及低钙症状发生率。术后随访4周，观察比较两组患者饮水呛咳、声音嘶哑、手足抽搐或麻木、喉返神经损伤、呼吸困难或窒息感等并发症发生情况。结果两组患者手术时间、术中出血量、住院时间比较差异均无统计学意义（P〉0．05）。术后7d，观察组甲状旁腺功能减退（2．38％）、低钙血症（4．76％）、抽搐和惊厥低钙症状发生率（0．00％、0．00％）显著低于对照组（30．95％、40．47％、16．67％、7．14％），差异均有统计学意义（P〈0．05）。观察组饮水呛咳、声音嘶哑及手足抽搐或麻木发生率稍低于对照组，但差异无统计学意义（P〉O．05），两组并发症总发生率比较，差异有统计学意义（P〈0．05）。观察组患者中，27例接受单侧切除术，1例（3．70％）患者发生并发症；15例接受双侧切除术，4例（26．67％）患者发生并发症。对照组患者中，26例接受单侧切除术，5例（19．23％）患者发生并发症；16例患者接受双侧切除术，10例（62．50％）患者发生并发症。行单侧切除术的患者术后并发症的发生率低于行双侧切除的患者，差异有高度统计学意义（P〈0．01）。结论甲状腺被膜内次全切除术近期并发症发生情况较少，且单侧切除术术后的情况要优于双侧切除术术后的情况。

Objective To investigate the short-term complications of membrane subtotal thyroid resection. Methods 84 patients with thyroid diseases from September 2012 to September 2014 in the People＇s Hospital of Dongguan City were selected, and they were randomly divided into two groups, 42 patients of the observation group were given thyroid envelope subtotals excision; 42 patients of the control group were given the implementation of the outer envelope subtotals resection. Operation time, amount of bleeding during the operation, analgesic usage and hospitalization time of two groups were recorded and compared. The incidences of parathyroid function decline, hypocalcemia calcium symptoms, low calcium 7 days after operation were compared between the two groups. Patients were followed up for 4 weeks after operation, and the incidences of drinking cough, hoarseness, tetany or numbness, recurrent laryngeal nerve injury, difficuhy breathing or a sense of suffocation of patients in two groups were observed and compared. Results The operation time, intraoperative blood loss and hospital stay of two groups had no statistical significance （P 〉 0105）. After 7 days with operation, the incidences of parathyroid function decline （2.38%）, hypocalcaemia （4.76%） and tic and convulsions （0.00%, 0.00%） of observation group were significantly lower than the control group （30.95%, 40.47%, 16.67%, 7.14%）, the differences were statistically significant （P 〈 0.05）. The incidence of drinking cough, hoarseness, tetany or numbness in the observation group were lower than those of the control group, but the differences had no statistically significant （P 〉 0.05）, the total incidence of complications in the two groups had statistically significant difference （P 〈 0.05）. Patients in the observation group, 27 patients received unilateral resection, just 1 case had complication; 15 cases re- ceived bilateral resection, 4 cases （26.67%） had complications. In the control group, 26 cases received unilateral resection, 5 cases （19.23%） had complications; 16 cases received bilateral resection of the patients, 10 cases （62.50%） had complications. The incidence of the complications of those who accepted the unilateral resection was lower than thosewho accepted the bilateral resection, the difference was statistically significant （P 〈 0.01）. Conclusion In the treatment of thyroid diseases, the rate of membrane subtotal thyroid resection is lower than the outside capsule subtotal thyroid resection. In addition, unilateral resection is superior to that of bilateral resection.