精细化被膜解剖技术在甲状腺癌患者近全切除术中的应用效果

Application effects of fine capsule dissection technique in subtotal resection of thyroid cancer patients

目的:分析精细化被膜解剖技术在甲状腺癌患者近全切除术中的应用效果。方法:回顾性分析2017年1月至2019年1月的72例甲状腺癌手术患者的临床资料,根据手术方法不同分为观察组和对照组,每组36例。对照组予传统甲状腺近全切除术治疗,观察组予精细被膜解剖技术的甲状腺近全切除术治疗,比较两组手术相关指标(术中出血量、手术时间、术后引流量)水平,喉返神经损伤、甲状旁腺损伤发生率,以及术前、术后血清甲状旁腺激素(PTH)、Ca2+水平。结果:观察组术中出血量及术后24 h引流量均少于对照组,手术时间均短于对照组,差异有统计学意义(P<0.05)。观察组暂时性喉返神经损伤发生率及甲状旁腺损伤发生率均低于对照组,差异有统计学意义(P<0.05);两组永久性喉返神经损伤及甲状旁腺损伤发生率比较,差异均无统计学意义(P>0.05)。两组术后7 d、1个月的PTH、Ca2+水平均呈先下降后升高趋势,且观察组高于对照组,差异有统计学意义(P<0.05);两组术后6个月PTH、Ca2+水平恢复至术前,组间差异无统计学意义(P>0.05)。结论:在全甲状腺近全切除术中应用精细被膜解剖技术,可缩短手术时间、减少出血量及引流量,有效降低对喉返神经、甲状腺旁腺功能损伤风险。

Objective:To evaluate application effects of fine capsule dissection technique in subtotal resection of thyroid cancer patients.Methods:The clinical data of 72 patients with thyroid cancer admitted from January 2017 to January 2019 were retrospectively analyzed.They were divided into observation group and control group according to different surgical methods,36 cases in each group.The control group was treated with conventional subtotal thyroidectomy,while the observation group was treated with subtotal thyroidectomy with fine capsule dissection.The surgical indicators(intraoperative blood loss,operation time,and postoperative drainage),incidence rates of recurrent laryngeal nerve injury and parathyroid injury,and serum parathyroid hormone(PTH)and Ca2+levels before and after the surgery were compared between the two groups.Results:The intraoperative blood loss and the drainage volume 24 h after the surgery were lower in the observation group than those in the control group;the operation time was shorter than that in the control group;and the differences were statistically significant(P<0.05).The incidence rates of temporary recurrent laryngeal nerve injury and parathyroid injury in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).There were no significant differences in the incidence rates of permanent recurrent laryngeal nerve injury and parathyroid injury between the two groups(P>0.05).The PTH and Ca2+levels of the two groups decreased first and then increased 7 days and 1 month after the surgery.The levels of PTH and Ca2+in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).The levels of PTH and Ca2+in the two groups recovered to the preoperative levels 6 months after the surgery,and there were no significant differences between the two groups(P>0.05).Conclusions:The application of fine capsule dissection during the subtotal thyroidectomy of the thyroid cancer patients can shorten the operation time,reduce the amount of bleeding and drainage,and effectively reduce the risk of recurrent laryngeal nerve and parathyroid injuries.