不同术式在分化型甲状腺癌术后喉返神经损伤、低钙血症的对比分析

Comparative study on the impact of surgical method on the occurrence of laryngeal nerve injury and hypocalcaemia in the treatment of differentiated thyroid carcinoma

目的探讨不同手术方式在治疗分化型甲状腺癌术后喉返神经损伤、低钙血症发生的比较。方法将2016年1月—2017年1月收治的96例手术治疗的分化型甲状腺患者,根据手术方式不同分为甲状腺全切除组26例,甲状腺全切除术+颈清组22例,腺体及峡部切除组20例,腺体及峡部切除术+对侧大部切除组28例。对比分析各组术后喉返神经损伤、低钙血症、临床疗效以及肿瘤复发等情况。结果不同术式术后喉返神经损伤发生率比较无差异(P>0.05);全切组、全切+颈清组低钙血症发生率明显高于腺体及峡部切除组(P<0.05),全切组、全切+颈清组低钙血症发生率明显高于腺体及峡部切除+对侧大部切除组(P<0.05),全切组与全切+颈清组低钙血症发生率比较无差异(P>0.05);随访1年,单纯全切组、全切+颈清组肿瘤复发率低于腺体及峡部切除组、腺体及峡部切除+对侧大部切除组(P<0.05),单纯全切组与全切+颈清组、腺体及峡部切除组肿瘤复发率比较无统计学意义(P>0.05)。结论分化型甲状腺癌的不同术式对术后血钙水平有影响,应根据不同病变范围严格按照指南选择适当的手术方式。

Objective To compare the occurrence of recurrent laryngeal nerve injury and hypocalcaemia underwent different surgical procedures in the treatment of differentiated thyroid carcinoma.Methods 96 cases of patients with differentiated thyroid and got treatment during January 2016 to January 2017 were divided into total thyroidectomy group （26 cases）, total thyroidectomy plus neck dissection group （22 cases）, thyroid gland and isthmus resection group （20 cases ） and glandular and isthmus resection plus contra lateral subtotal resection group （28 cases）. The conditions of recurrent laryngeal nerve injury, hypocalcaemia and clinical efficacy and tumor recurrent were compared. Results There was no difference in the incidence of recurrent laryngeal nerve injury after the operation （P〉0. 05）. The incidences of hypocalcaemia in the total thyroidectomy group and the total thyroidectomy plus neck dissection group were significantly higher than the thyroid gland and isthmus resection group, glandular and isthmus resection plus contra lateral subtotal resection group （P〈0.05）. There was no differences in the incidence of hypoealeaemia between total thyroidectomy group and total thyroideetomy plus neck dissection group （P〉 0. 05 ）. After been followed up for one year, the recurrence rates of the total thyroidectomy group and total thyroidectomy plus neck dissection group were lower than those in the thyroid gland and isthmus resection group, glandular and isthmus resection plus contra lateral subtotal resection group （P〈0. 05）. The difference of recurrence rate among the total thyroidectomy group, total thyroidectomy plus neck dissection group, thyroid gland and isthmus resection group were not statistically significant （P 〉 0. 05 ）. Conclusions Different types of operation perform influence on the concentration of blood calcium in patients with differentiated thyroid carcinoma. We should choose the appropriate operation way according to different lesion ranges.