精细化被膜解剖切除腺叶与传统集束状结扎切除腺叶对甲状腺癌患者甲状旁腺功能的影响

Effects of Meticulous Capsule Dissection and Traditional Cluster Ligation Thyroid Lobectomy on Parathyroid Function in Patients with Thyroid Cancer

目的评价精细化被膜解剖切除腺叶与传统集束状结扎切除腺叶对甲状腺癌(TC)患者甲状旁腺功能的影响。方法选取2016年1月—2017年12月收治的78例TC患者为研究对象,按照治疗方法分为对照组和观察组,每组39例。对照组行传统集束状结扎切除腺叶,观察组行精细化被膜解剖切除腺叶。比较2组的手术学指标、血清甲状旁腺激素(PTH)和Ca^2+浓度变化、并发症发生率及近期随访情况。结果2组手术时间、术中出血量和住院时间比较差异无统计学意义(P>0.05);观察组淋巴结清扫数量明显高于对照组(P<0.05)。术后1周,2组血清PTH较术前明显降低,对照组血清Ca^2+浓度较术前明显降低,且观察组血清PTH和Ca^2+浓度明显高于对照组(P<0.05);观察组暂时性喉返神经损伤和甲状旁腺损伤发生率、低钙血症发生率明显低于对照组(P<0.05);2组近期复发率比较差异无统计学意义(P>0.05)。结论精细化被膜解剖切除腺叶在不影响TC患者手术疗效和近期预后的情况下,相较传统集束状结扎切除腺叶能更有效的保护甲状旁腺功能和喉返神经,且手术安全性更佳。

Objective To evaluate effects of meticulous capsule dissection and traditional cluster ligation thyroid lobectomy on parathyroid function in patients with thyroid cancer(TC).Methods A total of 78 TC patients admitted during January 2016 and December 2017 were divided into control group and observation group(n=39 in each group)according to therapeutic methods.Control group underwent traditional cluster ligation thyroid lobectomy,while observation group underwent meticulous capsule dissection thyroid lobectomy.Related operative indexes,changes of serum parathyroid hormone(PTH)and Ca^2+ concentrations,incidence rate of complication and condition of short-time follow-up were compared between two groups.Results There were no significant differences in operative time,intraoperative volume of blood loss and hospitalization time between two groups(P>0.05).Number of lymph node dissection in observation group was significantly higher than that in control group(P<0.05).In one week after operation,serum PTH levels were significantly lower than those before operation in two groups;serum Ca^2+ concentration was significantly lower than that before operation in control group,and serum PTH and Ca^2+ concentrations in observation group were significantly higher than those in control group(P<0.05).Incidence rate of temporary recurrent laryneal nerve damage,parathyroid injury and hypocalcemia in observation group were significantly lower than those in control group(P<0.05).There was no significant difference in short-time recurrence rate between two groups(P>0.05).Conclusion Meticulous capsule dissection thyroid lobectomy may more effectively protect parathyroid function and recurrent laryngeal nerve on the basis of without affecting curative effect and short-term prognosis of TC patients than those by traditional cluster ligation thyroid lobectomy with good safety.