经颈带状肌间入路治疗甲状腺乳头状癌疗效分析

Analysis of the therapeutic effect of via cervical strap muscles approach in thyroid papillary carcinoma

目的评估颈带状肌间入路法在术中识别并保护喉上神经外侧支及甲状腺上动脉分支的效果。方法将2016年1月-2016年4月就诊于新疆医科大学附属肿瘤医院乳腺头颈外科接受单侧腺叶及峡部切除的80例甲状腺乳头状癌患者,随机分为经颈带状肌间入路组(40例)和颈白线入路组(40例)2组,分析两种术式喉上神经外侧支探查时间、术后患者嗓音障碍指数。分析2组患者喉上神经外侧支术中检出率及术后甲状旁腺功能低下发生率。结果经颈带状肌间入路法喉上神经探查时间、术后嗓音障碍指数明显低于经颈白线入路法;经颈带状肌间入路法较颈白线入路法喉上神经探查时间明显缩短,术后甲状旁腺功能低下发生率明显减少,差异有统计学意义(P <0.05)。结论经颈前带状肌间的自然间隙入路显露甲状腺上野,既避免了胸骨甲状肌的离断,又可最大程度扩大术野,在临床实践中对甲状腺手术有很大的帮助,值得在临床中推广。

Objective To investigate the function of cervical strap muscles approach on identifying and protecting the superior laryngeal nerve and the superior thyroid artery.Methods 80 patients with thyroid papillary carcinoma were collected and all patients underwent unilateral lobectomy and isthmus resection in the Department of Breast and Head-Neck Surgery,the Affiliated Tumor Hospital of Xinjiang Medical University from January 2016 to April 2016.80 patients were randomly and equally divided into 2 groups:via cervical strap muscles approach group(40 cases)and via linea alba cervicalis approach group(40 cases).We analyzed the exploration time of the lateral branch of the superior laryngeal nerve and voice handicap index after operation and compared the differences of lateral branch of the superior laryngeal nerve detection ratio and hypoparathyroidism after operation.Results The laryngeal nerve approach time and the voice handicap index in the group of via cervical strap muscles approach were significantly lower than those of via linea alba cervicalis approach.Nerve exploration time was significantly shorter and the incidence of postoperative parathyroid dysfunction was significantly reduced,and the difference was statistically significant(P<0.05).Conclusion The natural interspace of the thyroid upfield became more visible via cervical strap muscles approach not only avoids the breakage of the sternum thyroid muscle but also maximizes the surgical field,which is of great help in thyroid surgery in clinical practice.