摘要
目的探讨常规暴露式甲状腺切除术与精细化甲状腺被膜解剖术联合环甲间隙显露喉返神经的方法治疗恶性甲状腺肿瘤的效果。方法选取2016年12月至2020年6月间上海市第八人民医院收治的85例Ⅰ~Ⅲ级恶性甲状腺肿瘤患者,根据手术方法将其分为对照组(35例)和观察组(50例)。对照组采用常规暴露式甲状腺切除术治疗,观察组则给予患者精细化甲状腺被膜解剖术联合环甲间隙显露喉返神经手术治疗。比较两组患者手术情况、甲状旁腺素(PTH)、血清Ca^(2+)水平、免疫功能及喉返神经损伤情况。结果两组患者手术时间、术中出血量、淋巴结清扫数目和住院时间比较,差异无统计学意义(P>0.05)。治疗后,两组患者血清PTH及Ca^(2+)水平均低于治疗前,且对照组患者下降幅度大于观察组,差异均有统计学意义(均P<0.05)。治疗前,两组患者外周血CD4^(+)、CD8^(+)细胞比例及CD4^(+)/CD8^(+)对比,差异无统计学意义(P>0.05)。治疗后,两组CD4^(+)细胞比例降低,CD8^(+)细胞比例略有升高,CD4^(+)/CD8^(+)上升。同时观察组治疗后及治疗3个月后CD4^(+)/CD8^(+)高于对照组,差异均有统计学意义(均P<0.05)。对照组喉返神经损伤情况较观察组严重,差异有统计学意义(P<0.05)。结论与传统常规暴露式甲状腺切除术相比,精细化的甲状腺被膜解剖术配合环甲间隙暴露喉返神经后,甲状腺切除术的效果更优,其对患者的甲状旁腺功能和喉返神经损伤较小,有助于患者术后免疫功能恢复,值得临床应用推广。
Objective To compare the effects of conventional open thyroidectomy and fine capsule dissection combined with exposure of recurrent laryngeal nerve in cricothyroid space in the treatment of malignant thyroid tumors.Methods Eighty-five patients with grade I to III malignant thyroid tumors were selected at Shanghai Eighth People’s Hospital from December 2016 to June 2020.According to the operation method,they were divided into an observation group(50 patients)and a control group(35 patients).The observation group underwent fine capsule dissection combined with exposure of recurrent laryngeal nerve in cricothyroid space and the control group underwent conventional open thyroidectomy.The operation,parathyroid hormone(PTH),serum calcium,function of the immune system and recurrent laryngeal nerve injury were compared between the two groups.Results There was no significant difference in the duration of operation,intraoperative blood loss,the number of lymph nodes removed and length of hospital stay between the two groups(P>0.05).After the treatment,the serum PTH and calcium levels decreased in both groups and the decrease were higher in the control group than in the observation group(all P<0.05).Before the treatment,there was no significant difference in the levels of CD4^(+),CD8^(+) and CD4^(+)/CD8^(+) between the two groups(P>0.05).After the treatment,the proportion of CD4^(+)cells decreased and the proportion of CD8^(+) and CD4^(+)/CD8^(+) increased slightly in both groups.Meanwhile,CD4^(+)/CD8^(+) was significantly higher in the observation group than in the control group immediately after the treatment and at 3 months after the treatment(all P<0.05).Recurrent laryngeal nerve injury was more severe in the control group than in the observation group(P<0.05).Conclusion Compared with the traditional open thyroidectomy,fine capsule dissection combined with thyroidectomy exposing recurrent laryngeal nerve in the cricothyroid space shows good efficacy.It has less damage to the parathyroid function and recurrent laryngeal nerve,and is helpful to the recovery of function of the immune system,which is worthy of clinical application and promotion.
作者
吴凯锴
郇金亮
唐小龙
陈俊
WU Kai-kai;HUAN Jin-liang;TANG Xiao-long;CHEN Jun(Department of General Surgery,Shanghai Eighth People's Hospital,Shanghai 200235,China;Department of Oncology,Shengjing Hospital Affiliated to China Medical University,Shenyang 110004,China)
出处
《中国肿瘤临床与康复》
2022年第5期593-596,共4页
Chinese Journal of Clinical Oncology and Rehabilitation
关键词
甲状腺肿瘤
甲状腺切除术
甲状旁腺功能
喉返神经
免疫功能
Thyroid neoplasms
Thyroidectomy
Parathyroid gland function
Recurrent laryngeal nerve
Function of the immune system
