神经保护技术联合改良手术通道在甲状腺乳头状癌TOET中的应用

Application of Neuroprotective Technique Combined with Modified Surgical Channel in TOET for Papillary Thyroid Carcinoma

目的探究神经保护技术联合改良手术通道在甲状腺乳头状癌(PTC)经口腔甲状腺切除术(TOET)中的应用效果。方法选取2019年6月—2022年1月收治的PTC 180例,随机分为对照组和联合组各90例。对照组采用常规TOET,联合组在TOET中采用神经保护技术联合改良手术通道。比较2组手术一般情况、手术前后甲状旁腺功能和术后1、3周颏神经功能及并发症发生情况,记录复发及转移情况。结果2组均无中转开放手术者。联合组住院时间短于对照组(P<0.05)。术后24、72 h,2组血钙、甲状旁腺激素水平低于术前,但联合组高于对照组(P<0.05)。2组术后24、72 h血磷水平高于术前(P<0.05)。联合组术后1、3周改良英国医学研究理事会感觉分级优于对照组,并发症总发生率低于对照组(P<0.05,P<0.01)。2组均未发生复发及转移。结论TOET中采用神经保护技术联合改良手术通道能降低PTC患者神经损伤风险,改善甲状旁腺功能,有助于术后恢复,减少并发症。

Objective To explore the application value of neuroprotective techniques combined with modified surgical channel for transoral endoscopic thyroidectomy(TOET).Methods A total of 180 cases of papillary thyroid carcinoma(PTC)admitted from June 2019 to January 2022 were selected and randomly divided into control group(n=90)and combination group(n=90).The control group received conventional TOET,and the combination group received neuroprotective technology combined with modified surgical channel technique in TOET.The general condition,parathyroid function before and after surgery,mental nerve function and complications at 1 week and 3 weeks after surgery were compared between the two groups,and recurrence and metastasis were recorded.Results There was no conversion to open surgery in the two groups.The length of hospital stay in the combination group was shorter than that in the control group(P<0.05).The levels of blood calcium and parathyroid hormone at 24 h and 72 h after surgery were higher than those before surgery,and higher in the combination group than in the control group(P<0.05).The blood phosphorus levels in both groups were higher at 24 and 72 h after surgery than those before surgery(P<0.05).The modified British Medical Research Council sensory classification at 1 and 3 weeks after surgery was better than that in the control group,and the total complication rate was lower than that in the control group(P<0.05,P<0.01).No recurrence or metastasis occurred in the two groups.Conclusion In the treatment of PTC by TOET,neuroprotective technique combined with modified surgical channel can reduce the risk of nerve injury,improve parathyroid function,facilitate postoperative recovery and reduce complications.