通过胸甲韧带寻找下位甲状旁腺的临床应用价值分析

Analysis of the clinical value of finding the lower parathyroid glands through the pleural ligament

目的探讨通过胸甲韧带寻找下位甲状旁腺(LPG)的应用价值。方法选取2018年8月—2020年8月江苏省邳州市中医院收治的甲状腺病变拟行手术治疗患者110例为研究对象,按随机数字表法分为A组(55例,采用精细被膜解剖法甲状腺手术)、B组(55例,在A组的基础上另通过胸甲韧带寻找LPG)。比较两组术中寻找LPG情况,记录胸甲韧带的解剖结构及LPG位置,比较两组手术前后甲状旁腺功能、炎症指标及术后并发症情况。结果B组找到LPG人数多于A组,差异有统计学意义(P<0.05)。B组患者胸甲韧带多为上窄下宽的条状脂肪结缔组织结构,多起于人体胸腺颈段尖端,终点止于甲状腺,其中43例患者的胸甲韧带的终点位于甲状腺下极下侧1/3背侧位置,韧带内含有脂肪组织及血管;B组55例患者中21例LPG位于胸甲韧带的甲状腺止点周围,13例LPG位于胸甲韧带内,2例LPG位于胸腺颈段内,9例LPG位于胸甲韧带周围。两组术前甲状旁腺激素(PTH)、C反应蛋白(CRP)、血Ca^(2+)水平比较,差异无统计学意义(P>0.05),两组术后1 d PTH、血Ca^(2+)水平均低于术前,差异有统计学意义(P<0.05),且B组术后1 d PTH、血Ca^(2+)水平均高于A组,差异有统计学意义(P<0.05);两组术后1 d CRP水平均高于术前,差异有统计学意义(P<0.05),且B组术后1 d CRP水平低于A组,差异有统计学意义(P<0.05)。B组总并发症发生率低于A组,差异有统计学意义(P<0.05)。结论通过胸甲韧带寻找LPG可有效定位并保留LPG,减轻炎症水平,降低术后并发症的发生。

Objective To explore the application value of finding the lower parathyroid gland(LPG)through the pleural ligament.Methods A total of 110 patients with thyroid lesions undergoing surgical treatment who were admitted to Pizhou Hospital of Traditional Chinese Medicine from August 2018 to August 2020 were selected as the research objects.They were divided into group A(55 cases,thyroid surgery using fine capsule anatomy)and group B(55 cases,on the basis of group A,another LPG was searched through the pectoral ligament)according to a random number table.The LPG search conditions in the two groups were compared during the operation.The anatomical structure of the pleural ligament and the location of the LPG were recorded.The parathyroid function,inflammatory indexes and ostoperative complicationsof the two groups were compared before and after the operation.Results The proportion of people finding LPG in group B was higher than that in group A,the difference was statistically significant(P<0.05).The pleura ligament group B was mostly a narrow strip of fat connective tissue structure with a narrow upper and lower width.Among the 43 patients,the end point was located at the lower 1/3 of the dorsal position of the lower pole of the thyroid,and the ligament contains adipose tissue and blood vessels.Among the 55 patients in group B,21 cases of the LPG was located around the thyroid stop of the pleural ligament,13 cases of the LPG was located in the pleural ligament,2 cases of the LPG were located in the neck of the thymus,and 9 cases of the LPG was located around the pleural ligament.The preoperative parathyroid hormone(PTH),C-reactive protein(CRP),and blood Ca^(2+)levels were compared in the two groups before surgery,the difference was not statistically significant(P>0.05).The PTH and blood Ca^(2+)levels at 1 day after operation in the two groups were lower than before operation,the differences were statistically significant(P<0.05),and the PTH and blood Ca^(2+)levels at 1 day after operation in group B were higher than group A,the differences were statistically significant(P<0.05).The level of CRP at 1 day after operation in the two groups was higher than before operation,the difference was statistically significant(P<0.05),and the level of CRP at 1 day after operation in group B was lower than group A,the difference was statistically significant(P<0.05).The overall incidence of complications in group B was lower than that in group A,the difference was statistically significant(P<0.05).Conclusion Searching for LPG through the pectoral ligament can effectively locate and retain LPG,reduce the level of inflammation,and reduce the occurrence of postoperative complications.