甲状腺内侧气管旁入路在甲状腺癌根治术中的临床研究

Clinical study of the medial paratracheal approach in radical surgery for thyroid cancer

目的探讨开放性甲状腺癌根治术中应用甲状腺内侧气管旁入路的手术方式。方法选取河南省人民医院甲状腺外科2023年1月至2023年10月行甲状腺癌根治术的180例患者临床资料,采用随机数字表法将患者分为对照组和观察组,其中90例患者应用传统甲状腺外侧入路(对照组),另90例患者应用甲状腺内侧气管旁入路(观察组),比较两组患者手术时间、术中出血量;术后声音嘶哑、低钙症状;术后引流量、拔管时间、术后住院天数;术后1、3、5、30 d分别检测两组血清Ca^(2+)及甲状旁腺激素(PTH)水平,组间比较采用t检验、轶和检验及χ^(2)检验。结果观察组术中出血量及手术时间均明显少于对照组[(10±4)ml、(67±8)min比(18±5)ml、(95±12)min],差异有统计学意义(t=-6.687、-3.121,P<0.05),低钙症状患者分别为观察组1例,对照组8例,差异有统计学意义(χ^(2)=5.731,P<0.05);观察组患者术后1、3、5、30 d血清Ca^(2+)[(2.23±0.15)、(2.25±0.18)、(2.24±0.14)、(2.28±0.12)mmol/L]明显高于对照组[(2.12±0.13)、(2.15±0.22)、(2.18±0.19)、(2.20±0.15)mmol/L],差异有统计学意义(t=0.243、0.312、0.358、0.406,P<0.05);观察组血清PTH[(22.3±6.8)、(25.2±5.8)、(24.8±6.3)、(33.7±5.1)pg/ml]明显高于对照组[(15.8±5.6)、(16.3±7.9)、(18.2±8.5)、(24.6±7.2)pg/ml],差异有统计学意义(t=2.982、0.284、0.233、0.282,P<0.05)。结论甲状腺癌根治术应用甲状腺内侧气管旁入路,操作快捷,术野清晰,能很好的保护喉返神经及甲状旁腺的功能,手术入路安全可靠。

Objective To explore the application of medial parathoracic approach to the thyroid gland in open radical thyroid cancer surgery.MethodsThe clinical data of 180 patients who underwent radical thyroid cancer surgery in the Department of Thyroid Surgery of Henan Provincial People’s Hospital from January 2023 to October 2023 were selected.The patients were divided into control group and observation group by the random number table method,in which 90 patients were subjected to the traditional lateral thyroid approach(control group),and the other 90 patients were given the medial parathyroidal approach(observation group).The operation time,intraoperative bleeding,postoperative hoarseness and hypocalcemia symptoms were compared between the two groups.Postoperative drainage volume,extubation time,postoperative hospitalization days,serum Ca^(2+)and parathyroid hormone(PTH)levels were detected at 1st,3rd,5th,and 30th d postoperatively,respectively.Differences between groups were analyzed by t test,rank sum test and χ^(2) test.ResultsIntraoperative bleeding and operation time were significantly reduced in the observation group as compared with the control group[(10±4)ml and(67±8)min in the observation group;(18±5)ml and(95±12)min in the control group,t=-6.687,-3.121,P<0.05],and one case of hypocalcemic symptoms in the observation group and 8 cases in the control group(χ^(2)=5.731,P<0.05).Serum Ca 2+levels at 1st,3rd,5th,30th d postoperatively were(2.23±0.15),(2.25±0.18),(2.24±0.14),(2.28±0.12)mmol/L in the observation group,significantly higher than those in the control group correspondingly[(2.12±0.13),(2.15±0.22),(2.18±0.19),(2.20±0.15)mmol/L;t=0.243,0.312,0.358,0.406,P<0.05].Serum PTH level in the observation group was(22.3±6.8),(25.2±5.8),(24.8±6.3),(33.7±5.1)pg/ml respectively,also significantly higher than that in the control group correspondingly[(15.8±5.6),(16.3±7.9),(18.2±8.5),(24.6±7.2)pg/ml;t=2.982,0.284,0.233,0.282,P<0.05].ConclusionThe application of medial paratracheal approach to the thyroid gland for radical thyroid cancer surgery is a safe and reliable surgical access with fast operation,clear field,and good protection of the function of the recurrent laryngeal nerve and parathyroid glands.