分化型甲状腺癌术中喉返神经显露及不同腺叶切除对喉返神经及甲状旁腺功能的影响

Effects of DifferentRecurrent Laryngeal Resection on Recurrent Laryngeal Nerve and Parathyroid Function in Thyroidectomy with Differentiated Thyroid Carcinoma

目的探究分化型甲状腺癌甲状腺全切术中喉返神经显露及不同腺叶切除对喉返神经及甲状旁腺功能的影响。方法研究对象选取2014-01—2016-09收治的分化型甲状腺癌患者75例,依照随机数表法将其分为A,B,C3组,每组各25例。3组均予以甲状腺全切除术及单侧中央区淋巴结清扫治疗,A组未显露喉返神经,B组采取精细化被膜解剖结合环甲隙显露喉返神经法切除腺叶,C组采取常规术式结合甲状腺下动脉下路喉返神经法切除腺叶。对比3组手术情况、术后血清相关分子水平及不良反应发生率。结果 A组手术时间明显长于B、C组,差异具有统计学意义(P<0.05),而3组患者在术中出血量、淋巴结清除个数及意识恢复时间差异均无统计学意义(P>0.05)。术后1、4、7dB组患者的甲状旁腺激素水平与钙离子水平均明显高于C组,而C组亦明显高于A组,比较差异均具有统计学意义(P<0.05)。B、C组不良反应发生率明显低于A组,差异具有统计学意义(P<0.05)。结论喉返神经显露及精细化被膜解剖腺叶均可降低喉返神经损伤率及甲状旁腺功能的损伤,值得临床推广。

Objective To investigate the effects of recurrent laryngeal nerve and different lobectomy on recurrent laryngeal nerve and parathyroid function in thyroideetomy with differentiated thyroid carcinoma. Methods 75 patients with differentiated thyroid carcinoma were selected from January 2014 to September 2016. They were divided into A,B and C groups according to the random number table method, each group of 25 cases. All patients underwent total thyroidectomy and unilateral central area lymphadenectomy. Group A patients were not exposed to recurrent laryngeal nerve. Group B patients underwent fine anatomical dissection combined with ring gland clearance and recurrent laryngeal nerve. Group C patients with conventional surgery combined with the lower thyroid artery recurrent laryngeal nerve resection of the lobe. Comparison of three groups of patients with surgical conditions,postoperative serum-related molecular levels and the incidence of adverse reactions. Results The operation time of group A was significantly longer than that of group B and group C,the difference was statistically significant（P〈0.05） ;there was no significant difference in the number of bleeding, lymph node dissection and consciousness recovery between the three groups （P〈0.05）. The levels of parathyroid hormone and calcium were significantly higher in group B than those in group C at 1,4 and 7 days after operation, and group C was significantly higher than group A, the difference was statistically significant（P 〈0.05）. The incidence of adverse reactions in group B and C was significantly lower than that in group A, the difference was statistically signifi- cant（P〈0.05）. Conclusion Recurrent laryngeal nerve revealed and fine capsule dissection of the lobe can reduce the recurrent la- ryngeal nerve injury rate and parathyroid function damage,it is worth in the clinical promotion.