甲状腺全切除术不同手术入路显露甲状腺上动脉对甲状旁腺功能的影响

INFLUENCE OF DIFFERENT SURGICAL APPROACHES FOR EXPOSING THE SUPERIOR THYROID ARTERY ON PARATHYROID FUNCTION IN TOTAL THYROIDECTOMY

目的探讨甲状腺全切除术经环甲间隙入路和经带状肌间入路显露甲状腺上动脉对患者术后甲状旁腺功能的影响。方法我院行甲状腺双叶全切除术并双侧中央区淋巴结清扫术的甲状腺乳头状癌患者126例,按照手术方法不同分为经环甲间隙入路(环甲肌组)和经带状肌间入路(带状肌组)各63例,比较两组患者术中甲状腺上动脉清晰显露率、术前与术后第1天血清甲状旁腺素浓度差值、声音嘶哑发生率、音调改变发生率、暂时性甲状旁腺功能减退发生率。结果两组患者术中甲状腺上动脉清晰显露率及术后第1天暂时性甲状旁腺功能减退率、音调改变发生率比较差异均有显著性(χ^(2)=6.13~13.02,P<0.05);术前与术后第1天甲状旁腺素浓度差值比较差异有显著性(t=3.42,P<0.01)。结论与经环甲间隙入路相比,经带状肌间入路甲状腺全切除术可有效保护患者喉上神经,减少对甲状旁腺动脉的损伤,利于甲状旁腺的原位保留,减轻了手术对甲状旁腺功能的影响。

Objective To investigate the influence of exposure of the superior thyroid artery via the cricothyroid space approach versus the cervical strap muscles approach on parathyroid function after total thyroidectomy.Methods A total of 126 patients with papillary thyroid carcinoma who underwent total thyroidectomy and bilateral central lymph node dissection in our hospital were enrolled,and according to the surgical approach,they were divided into cricothyroid space approach group with 63 patients and cervical strap muscles approach group with 63 patients.The two groups were compared in terms of clear exposure rate of the superior thyroid artery during surgery,difference of serum parathyroid hormone concentration from before surgery to day 1 after surgery,and incidence rate of hoarseness,change in tone,and temporary hypoparathyroidism.Results There were significant differences between the two groups in the clear exposure rate of the superior thyroid artery during surgery and the incidence rates of temporary hypoparathyroidism and change in tone on day 1 after surgery(χ^(2)=6.13-13.02,P<0.05),and there was also a significant difference in the difference of serum parathyroid hormone concentration from before surgery to day 1 after surgery(t=3.42,P<0.01).Conclusion Compared with the cricothyroid space approach for total thyroidectomy,the cervical strap muscles approach can effectively protect the superior laryngeal nerve and reduce the damage to the parathyroid artery,which helps with the in situ preservation of parathyroid gland and reduces the impact of surgery on parathyroid function.