小切口腔镜辅助甲状腺手术中不同张力操作对上位甲状旁腺血运的影响

Influence on Blood Supply of Superior Parathyroid by Different Tractive Tentions in Minimally Invasive Video-assistant Thyroidectomy

目的观察小切口腔镜辅助甲状腺手术中不同张力操作对上位甲状旁腺血运的影响。方法选择2017年4~11月因T1a期甲状腺乳头状癌行一侧腺叶切除+同侧中央区淋巴结清扫术45例,回顾手术录像,判断解剖上位甲状旁腺过程中的张力及甲状旁腺的外观。根据上位甲状旁腺是否与甲状腺之间产生张力分为低张力与高张力解剖。上位甲状旁腺外观改变分为4度:正常外观为Ⅰ度,充血为Ⅱ度,淤血为Ⅲ度,无血供为Ⅳ度。结果 45例手术过程顺利。上位甲状旁腺外观Ⅰ度18例(40%),Ⅱ度19例(42%),Ⅲ度8例(18%),无Ⅳ度。低张力解剖26例,高张力解剖19例。低张力解剖的上位甲状旁腺外观情况好于高张力解剖[低张力解剖组Ⅰ、Ⅱ、Ⅲ度分别为14、11、1例,高张力解剖组为4、8、7例,Z=-2.870,P=0.004],但手术时间长[(57.4±11.6)min vs.(45.7±7.5)min,t=3.770,P=0.000]。结论低张力下完成上位甲状旁腺保留对其血运影响较小,但手术时间长。细致耐心的低张力解剖可能有利于甲状旁腺血运的保护。

Objective To observe the influence on supplying blood vessles of superior parathyroid（ SPT） by different tractive tentions in minimally invasive video-assistant thyroidectomy. Methods A total of 45 patients preoperatively diagnosed as thyroid papillary carcinoma in stage T1 a with indication for unilateral lobectomy and ipsilateral central lymph node dissection between April2017 to November 2017 were selected. By reviewing surgical video,patients were divided into lower tension group（ LT） and higher tension group（ HT） according to the tension between parathyroid and thyroid. The macroscopic change of SPT was observed and the influence on supplying blood vessles of remaining SPT was retrospectively analyzed. The macroscopic changes of SPT were divided into four levels： normal blood supply as degree Ⅰ,hyperemia as degree Ⅱ,congestion as degree Ⅲ,and no blood supply as degree Ⅳ.Results Forty-five patients underwent surgery smoothly. For macroscopic changes of SPT,there were 18 cases（ 40%） of degree Ⅰ,19 cases（ 42%） of degree Ⅱ,and 8 cases（ 18%） of degree Ⅲ,including 26 cases in the LT group and 19 cases in the HT group.The macroscopic change of SPT in the LT group was better than that in the HT group（ 14 cases of degree Ⅰ,11 cases of degree Ⅱ and1 case of degree Ⅲ in the LT group; and 4 cases of degree Ⅰ,8 cases of degree Ⅱ and 7 case of degree Ⅲ in the HT group,respectively,Z =-2. 870,P = 0. 004）. The operation time of the LT group was significantly longer than that of the HT group[（ 57. 4 ± 11. 6） min vs.（ 45. 7 ± 7. 5） min,t = 3. 770,P = 0. 000]. Conclusions Remaining SPT by low tension has less influence on its blood supply,but needs more operation time. Careful anatomic operation with lower tention may be beneficial for the protection of parathyroid blood supply.