胸乳入路腔镜下改良甲状腺次全切术对甲状腺功能亢进的疗效及对PTH、血清钙水平的影响

Effect of modified subtotal thyroidectomy through breast and chest approach on hyperthyroidism and its influence on PTH and blood calcium level

目的探究胸乳入路腔镜下改良甲状腺次全切术治疗甲状腺功能亢进的临床疗效及对术后甲状旁腺激素(PTH)、血清钙(Ca^(2+))水平的影响。方法前瞻性选取2019年1月至2021年5月淮南东方医院集团总医院收治的75例甲状腺功能亢进患者作为研究对象。按照随机数值表法将其分为试验组和常规组,常规组37例予以传统甲状腺次全切术,试验组38例予以胸乳入路腔镜下改良甲状腺次全切术。比较两组患者术前及术后1个月甲状腺功能[促甲状腺激素(TSH)及游离甲状腺素(FT4)]、术前及术后1周甲状旁腺功能(PTH、Ca^(2+))、术中出血量、术后引流量、手术时间及住院时间、术后并发症发生情况及术后3个月复发情况、美学满意度。结果术后1个月,两组患者TSH水平均明显高于术前,FT4水平均明显低于术前,差异均有统计学意义(P<0.05);术后1个月,两组患者TSH、FT4水平比较,差异均无统计学意义(P>0.05)。术后1周,两组患者PTH水平均明显低于术前,且试验组为(39.97±4.52)pg/mL,明显高于常规组[(33.01±3.94)pg/mL],差异均有统计学意义(P<0.05);术后1周,常规组Ca^(2+)明显低于术前,差异有统计学意义(P<0.05)。试验组术中出血量、术后引流量及住院时间为(36.09±6.19)mL、(25.03±3.29)mL、(3.42±0.88)d,明显低于或短于常规组[(64.17±5.28)mL、(31.91±4.11)mL、(4.63±1.01)d],手术时间为(99.67±13.05)min,明显长于对照组[(72.15±10.24)min],差异均有统计学意义(P<0.05)。两组患者术后3个月均无复发,试验组术后并发症发生率为2.63%,明显低于对照组(7.89%),差异有统计学意义(P<0.05)。试验组美学满意度为97.37%,明显高于对照组(83.78%),差异有统计学意义(P<0.05)。结论胸乳入路腔镜下改良甲状腺次全切术治疗甲状腺功能亢进,可有效促进TSH、FT4恢复正常,降低对甲状旁腺功能的损伤,降低患者术中出血量及术后引流量,缩短住院时间,术后并发症发生率低,且患者美学满意度较高。

Objective To explore the clinical efficacy of modified subtotal thyroidectomy through thoracic approach in the treatment of hyperthyroidism and its effect on postoperative parathyroid hormone(PTH)and serum calcium(Ca+)levels.Methods A total of 75 patients with hyperthyroidism who were admitted to the Huainan Oriental Hospital Group General Hospital in Anhui Province from January 2019 to May 2021 were prospectively selected as the research subjects.They were divided into experimental group and routine group according to the random number table method,37 patients in routine group received traditional subtotal thyroidectomy,and 38 patients in experimental group received modified subtotal thyroidectomy through thoracic breast approach.The thyroid function[thyroid-stimulating hormone(TSH)and free thyroxine(FT4)],parathyroid function(PTH,Ca 2+),and intraoperative bleeding before and 1 week after surgery were compared between the two groups of patients.The volume,postoperative drainage volume,operation time and hospital stay,postoperative complications and 3-month postoperative recurrence,aesthetic satisfaction were compared between the two groups.Results One month after operation,the levels of TSH in the two groups were significantly higher than those before operation,and the levels of FT4 were significantly lower than those before operation,the differences were statistically significant(P<0.05);1 month after operation,there was no significant difference in the levels of TSH and FT4 between the two groups(P>0.05).The PTH levels in the two groups 1 week after operation were significantly lower than those before operation,and the experimental group was(39.97±4.52)pg/mL,which was significantly higher than the routine group[(33.01±3.94)pg/mL],the differences were statistically significant(P<0.05);the postoperative Ca 2+in the routine group was significantly lower than that before operation,the differences were statistically significant(P<0.05).The intraoperative blood loss,postoperative drainage and hospital stay in the experimental group were(36.09±6.19)mL,(25.03±3.29)mL,(3.42±0.88)d,which were significantly lower or shorter than those in the conventional group[(64.17±5.28)mL,(31.91±4.11)mL,(4.63±1.01)d],and the operation time was(99.67±13.05)min,which was significantly longer than that in the control group[(72.15±10.24)min],the differences were statistically significant(P<0.05).There was no recurrence in the two groups 3 months after operation,and the incidence of postoperative complications in the experimental group was 2.63%,which was significantly lower than that in the control group(7.89%),the difference was statistically significant(P<0.05).The aesthetic satisfaction of the experimental group was 97.37%,which was significantly higher than that of the control group(83.78%),the difference was statistically significant(P<0.05).Conclusion Modified subtotal thyroidectomy through thoracic approach for the treatment of hyperthyroidism can effectively promote the return of TSH and FT4 to normal,reduce the damage to parathyroid function,reduce the amount of intraoperative blood loss and postoperative drainage,and shorten hospitalization time,low postoperative complication rates,and high patient aesthetic satisfaction.