改进的精细化被膜解剖法在甲状腺手术中的应用

Application of improved metlculous capsular dissection technique in thyroid surgery

目的探讨改进的精细化甲状腺被膜解剖法在甲状腺手术中的临床应用价值。方法回顾性分析2015年9月至2018年5月我院收治的126例甲状腺疾病手术患者的临床资料,依两医生随机收诊将其分为传统被膜解剖手术组(67例)和改进的精细化被膜解剖手术组(59例)。将传统被膜解剖法手术组分为传统单侧手术组(32例,良性病变)和传统双侧手术组(35例,PTC);将改进的精细化被膜解剖法手术组分为改进单侧手术组(29例,良性病变)和改进双侧手术组(30例,PTC)。比较传统单侧手术组和改进单侧手术组患者术中出血量、手术时间、甲状旁腺素、血钙及术后并发症发生情况;比较传统双侧手术组和改进双侧手术组患者术中出血量、淋巴结清扫个数、手术时间、甲状旁腺素、血钙、术后并发症发生情况及暂时性甲状旁腺功能减退恢复时间。结果改进双侧手术组的术中出血量、暂时性甲状旁腺功能减退发生率及并发症总发生率优于传统双侧手术组(P<0.05)。结论改进的更精细化被膜解剖法能够更进一步减少甲状腺手术特别是双侧手术术中出血量,降低术后暂时性甲状旁腺功能减退等并发症发生率,临床应用价值较高。

Objective To explore the clinical application value of improved metlculous capsular dissection technique in thyroid surgery.Methods The clinical data of 126 patients undergoing thyroid surgery treated in our hospital from September 2015 to May 2018 were retrospectively analyzed.The patients were divided into traditional capsular dissection group(67 cases)and improved metlculous capsular dissection group(59 cases)according to the random treatment by the two doctors.The traditional capsular dissection group was divided into traditional unilateral operation group(32 cases,benign lesions)and traditional bilateral operation group(35 cases,PTC);the improved metlculous capsular dissection group was divided into improved unilateral operation group(29 cases,benign lesions)and improved bilateral operation group(30 cases,PTC).The intraoperative blood loss,operation time,parathyroid hormone,blood calcium and postoperative complications were compared between the traditional unilateral operation group and the improved unilateral operation group;the intraoperative blood loss,number of lymph node dissection,operation time,parathyroid hormone,blood calcium,postoperative complications and recovery time of temporary hypoparathyroidism were compared between the traditional bilateral operation group and the improved bilateral operation group.Results The intraoperative blood loss,the incidence of temporary hypoparathyroidism and the total incidence of complications in the improved bilateral operation group were better than those in the traditional bilateral operation group(P<0.05).Conclusion The improved metlculous capsular dissection technique can further reduce intraoperative blood loss and the incidence of postoperative temporary hypoparathyroidism in thyroid surgery,especially bilateral surgery.It has higher clinical application value.