常规切除法、精细化切除法用于甲状腺腺叶切除对喉返神经及甲状旁腺的影响比较

Comparison of the effects of conventional resection and refined resection in thyroid gland lobectomy on recurrent laryngeal nerve and parathyroid gland

目的比较常规切除法、精细化切除法用于甲状腺腺叶切除对喉返神经及甲状旁腺的影响。方法选取在我院行甲状腺腺叶切除术的患者93例,按不同手术方法将其分为常规组(45例,采用常规切除法)和精细组(48例,采用精细化切除法)。比较两组手术操作相关指标(手术时间、术中出血量、淋巴结清扫数量),术后喉返神经损伤、甲状旁腺损伤及低钙血症发生率,术前、术后相关甲状腺激素水平。结果两组手术时间、术中出血量、淋巴结清扫数量比较,差异均无统计学意义(P>0.05)。精细组术后喉返神经损伤率为2.08%、甲状旁腺损伤率为2.08%,分别低于常规组的15.56%、17.78%(P<0.05)。术后1、3 d,两组血清甲状旁腺激素、血钙水平较术前降低,但精细组高于常规组(P<0.05)。结论与常规切除法相比,精细化切除法用于甲状腺腺叶切除术中,能减少喉返神经及甲状旁腺损伤的发生率,安全性高,值得临床推广。

Objective To compare the effects of conventional resection and refined resection in thyroid gland lobectomy on recurrent laryngeal nerve and parathyroid gland.Methods Ninety-three patients undergoing thyroid gland lobectomy in our hospital were selected,and the patients were divided into conventional group(45 cases,taking conventional resection)and fine group(48 cases,taking refined resection)according to different surgical methods.The related operation indexes(operation time,intraoperative blood loss,number of lymph node dissection),the incidences of recurrent laryngeal nerve injury,parathyroid gland injury and hypocalcemia,and the levels of relevant thyroid hormone before and after operation were compared between the two groups.Results There were no significant differences in operation time,intraoperative blood loss and number of lymph node dissection between the two groups(P>0.05).The injury rates of recurrent laryngeal nerve and parathyroid gland in the fine group were 2.08%and 2.08%respectively,which were lower than 15.56%and 17.78%in the conventional group(P<0.05).At 1 and 3 d after operation,the levels of serum parathyroid hormone and calcium in the two groups were lower than those before operation,but those in the fine group were higher than the conventional group(P<0.05).Conclusion Compared with the conventional resection,refined resection applied in thyroid gland lobectomy can reduce the incidences of recurrent laryngeal nerve and parathyroid gland injury,with high safety,which is worthy of clinical promotion.