精细化被膜解剖结合环甲间隙显露喉返神经对全甲状腺切除术患者甲状旁腺及喉返神经功能的影响

Effect of meticulous capsular dissection combined with exposure of recurrent laryngeal nerve in ring nail clearance on glandulae parathyroid and recurrent laryngeal nerve

目的:探讨精细化被膜解剖结合环甲间隙显露喉返神经法切除分化型甲状腺癌患者全甲状腺对甲状旁腺及喉返神经功能的作用.方法:筛选在佛山市中医院行全甲状腺切除的分化型甲状腺癌患者54例,按随机数字表法随机分为对照组27例和观察组27例,其中对照组随访期间脱落2例,实际完成25例.对照组采取血管主干切断、结扎结合甲状腺下动脉显露喉返神经法.观察组采取精细化被膜解剖结合环甲间隙显露喉返神经法.比较两组术中出血量、手术时间及淋巴结清扫数量及不良反应.检测两组血清甲状旁腺激素(Parathyroid Hormone,PTH)、钙离子(Ca2+)水平.随访比较两组复发率.结果:对照组和观察组患者术中出血量(17.11±1.97)mL vs(16.95±1.82)mL、手术时间(69.81±7.40)min vs(70.62±7.76)min,以及淋巴结清扫数量(4.94±0.55)个vs(4.89±0.57)个比较差异无统计学意义(P>0.05).术后2 d,观察组患者血清PTH水平明显高于对照组(P<0.01).观察组患者的暂时性喉返神经损伤、甲状旁腺损伤及低钙血症发生率分别为3.7%(1/27)、0.0%(0/27)、0.0%(0/27),明显低于对照组的28.0%(7/25)、28.0%(7/25)、24.0%(6/25)(P<0.05).观察组复发率7.41%(2/27),对照组复发率16%(4/25),两组比较差异无统计学意义(P>0.05).结论:与传统甲状腺手术比较,精细化被膜解剖结合环甲间隙显露喉返神经法切除分化型甲状腺癌患者全甲状腺,有效减少了暂时性甲状旁腺及喉返神经损伤的发生率.

Objective:To investigate role of meticulous capsular dissection combined with exposure of recurrent laryngeal nerve in ring gap dissecting thyroid gland of differentiated thyroid carcinoma case on glandulae parathyroideae and recurrent laryngeal nerve.Methods:Fifty-four differentiated thyroid carcinoma cases for dissecting of thyroid gland were selected and randomly divided into the control group(27 cases)and the observation group(27 cases),and 2 cases dropped in the control group.The control group was given cutting and ligation of vascular trunk combined with arteriae thyreoidea inferior exposing recurrent laryngeal nerve.The observation group was treated with meticulous capsular dissection combined with exposure of recurrent laryngeal nerve in ring gap.Intraoperative blood loss,operation time,number of lymph node dissection,and untoward effect were compared between two groups.Levels of parathormone and Ca2+were detected for both groups.The recurrence rate was compared between the two groups by follow up.Results:There was no statistically significant difference in comparison of intraoperative blood loss(17.11±1.97)mL vs(16.95±1.82)mL,operation time during operation(69.81±7.40)min vs(70.62±7.76)min and number of lymph node dissection(4.94±0.55)pcs vs(4.89±0.57)pcs in two groups(P>0.05).Levels of PTH of the observation group was obviously higher than that of the control group 2 days after operation(P<0.01).The temporary recurrent laryngeal nerve injury,parathyroid injury and hypocalcemia of the observation group was 3.7%(1/27),0.0%(0/27)and 0%(0/27)respectively,which were remarkably less than those of the control group 28.0%(7/25),28.0%(7/25),24.0%(6/25)(P<0.05).The recurrence rate of observation group was 7.41%,and that of the control group was 16%,and there was no statistically significant difference in comparison(P>0.05).Conclusion:Compared with traditional thyroid surgery,meticulous capsular dissection combined with exposure of recurrent laryngeal nerve in ring gap dissecting thyroid gland of differentiated thyroid carcinoma case can reduce incidence rate of injury of glandulae parathyroideae and recurrent laryngeal nerve.