腔镜甲状腺手术颈部分离层面的研究

Study on the neck anatomical level of endoscopic thyroidectomy

目的:探讨腔镜甲状腺手术颈部的主要操作空间层面。方法:采用随机对照的研究方法,将2017年2月至2017年8月收治的60例甲状腺手术患者分为A组(n=30,手术操作空间层面在颈阔肌与颈深筋膜浅层之间)、B组(n=30,手术操作空间层面在颈深筋膜浅层与颈前肌群之间)。对比分析两组患者术中出血量、术后血清C-反应蛋白水平、颈部紧张感、疼痛感及颈部皮肤感觉异常面积。结果:两组术中出血量、手术时间、住院时间、术后颈部紧张感、疼痛感及感觉异常面积差异无统计学意义(P>0.05)。术后24 h、48 h,B组患者血清C-反应蛋白低于A组,差异有统计学意义(P<0.05)。结论:腔镜甲状腺手术中,在颈深筋膜浅层与颈前肌群之间建立手术空间的早期炎症反应较颈阔肌与颈深筋膜浅层之间轻,且不会增加颈部紧张感、疼痛感、颈部感觉异常等。

Objective:To investigate the cervical main operating space of endoscopic thyroid surgery.Methods:A randomized controlled method was used.The 60 patients of thyroid surgery from Feb.2017 to Aug.2017 were divided into two groups.The surgical space of group A(n=30) was between the platysma and superficial layer of deep cervical fascia.The surgical level of group B(n=30) was between the superficial layer of deep cervical fascia and jugular anterior fascicles.The intraoperative blood loss,postoperative serum C-reactive protein levels,neck tension,pain and paresthesia of skin area in the neck were compared between the two groups.Results:There was no significant difference in intraoperative blood loss,operation time,hospital stay,neck tension,pain and paresthesia of skin area between the two groups(P>0.05).The serum C-reactive protein of 24 h and 48 h after operation in group B was less than that in group A(P<0.05).Conclusions:In endoscopic thyroidectomy,creation of operative space between the superficial layer of deep cervical fascia and jugular anterior fascicles is better than between the platysma and superficial layer of deep cervical fascia in the early inflammatory response,and does not increase neck tension,pain or cervical paresthesia.