系膜分层解剖法在全甲状腺切除术对上位甲状旁腺的保护探讨

Protection of upper parathyroid gland by mesangial stratification anatomy in total thyroidectomy

目的探讨系膜分层解剖法应用于全甲状腺切除术患者中对于上位甲状旁腺的保护作用。方法选择在郑州大学第一附属医院2021年12月—2022年12月期间接受全甲状腺切除术的甲状腺癌患者80例,随机分为试验组和参照组,每一组患者为40例。试验组实施系膜分层解剖法,参照组实施传统脱帽法进行治疗;对比2组患者的手术时间、上位甲状旁腺原位保留率、术中喉返神经损伤率、血钙水平变化情况、甲状旁腺素水平变化情况、术后并发症发生率以及住院时间。结果两组比较,试验组患者的术中上位甲状旁腺原位保留率(95.00%)高于参照组(P<0.05);试验组术中喉返神经损伤占比为2.50%,与参照组比较差异均无统计学意义(P>0.05);术后1天,两组患者的血钙水平对比无差异(P>0.05);在术后4周时,两组患者的血钙水平较比术后1 d时有所提升,对比差异有统计学意义(P<0.05);但组间对比差异无统计学意义(P>0.05)。术后1天,试验组甲状旁腺素指标测定值高于参照组,组间对比差异有统计学意义(P<0.05);在术后4周时,两组患者的甲状旁腺素水平与术后1 d时均有所提升,对比差异有统计学意义(P<0.05);但组间甲状旁腺素水平对比无明显差异(P>0.05);试验组患者术后并发症发生率为5.00%,与参照组的25.00%对比差异有统计学意义(P<0.05);试验组患者的手术时间、住院时间与参照组比较无差异(P>0.05)。结论在甲状腺全切术中以系膜分层解剖法处理甲状腺上极,能够较好的原位保留患者上位甲状旁腺,并降低术后并发症。

Objective To investigate the protective effect of mesangial layered anatomy on superior parathyroid gland in patients undergoing total thyroidectomy.Methods A total of 80 patients with thyroid cancer who underwent total thyroidectomy in the First Affiliated Hospital of Zhengzhou University from December 2021 to December 2022 were randomly divided into experimental group and reference group,with 40 patients in each group.The experimental group was treated by mesangial stratification dissection,and the reference group was treated by traditional hat removal.The operation time,in situ retention rate of upper parathyroid gland,intraoperative injury rate of recurrent laryngeal nerve,changes in blood calcium level,changes in parathyroid hormone level,incidence of postoperative complications and length of hospital stay were compared between the two groups.Results The intraoperative retention rate of upper parathyroid gland in the experimental group(95.00%)was higher than that in the reference group(P<0.05).The proportion of recurrent laryngeal nerve injury in the experimental group was 2.50%,and there was no significant difference between the experimental group and the reference group(P>0.05).On the first day after surgery,there was no difference in blood calcium level between the two groups(P>0.05).At 4 weeks after surgery,the blood calcium level of the two groups was higher than that of the first day after surgery,and the difference was statistically significant(P<0.05).There was no significant difference between the two groups(P>0.05).On the first day after operation,the parathyroid hormone index of the experimental group was higher than that of the reference group,and the difference between groups was statistically significant(P<0.05).At 4 weeks after surgery,the level of parathyroid hormone in two groups was increased compared with that at 1 day after surgery,with statistical significance(P<0.05).There was no significant difference in parathyroid hormone levels between groups(P>0.05).The incidence of postoperative complications was 5.00%in the experimental group and 25.00%in the reference group(P<0.05).There was no difference in operation time and hospital stay between the experimental group and the reference group(P>0.05).Conclusion In total thyroidectomy,stratified mesangial dissection of the upper pole of thyroid can preserve the upper parathyroid gland in situ and reduce postoperative complications.