摘要
目的探讨颈侧方切口经胸锁乳突肌肌间入路手术(SMIA)在治疗原发性甲状旁腺功能亢进症中的可行性及其临床效果。方法回顾性分析2019年1月-2022年6月浙江大学医学院附属第一医院行单侧甲状旁腺手术的64例原发性甲状旁腺功能亢进症患者的临床资料,根据手术切口及入路分为颈侧方切口SMIA组及正中切口颈白线入路组(LACA组)。比较两组间临床特征、手术相关结果及术后颈前区功能的差异。采用EQ-5D-5L量表评估术后颈部不适主观感受,Hollander伤口评估量表评定切口愈合情况。结果两组患者在年龄、性别、术中出血、手术前后甲状旁腺激素及血钙水平等方面均无统计学差异(P>0.05)。SMIA组平均手术时间[(39.77±5.69)min]明显少于LACA组[(54.41±4.66)min]。术后1月及12月,两组在颈前区功能保护方面有统计学差异(1月:84.67±3.74 vs.79.47±5.38,P<0.001;12月:93.80±2.52 vs.89.94±2.39,P<0.001),且SMIA组均优于LACA组;SMIA组术后6月及12月的Hollander切口评估量表得分优于LACA组,差异有统计学意义(6月:1.93±0.58 vs.2.41±0.66,P=0.003;12月:1.03±0.67 vs.1.74±0.62,P<0.001)。结论颈侧方切口经胸锁乳突肌肌间入路行甲状旁腺切除是简便、安全及有效的手术方式,较于传统切口更易寻找甲状旁腺病变,缩短手术时间,且对颈前区功能保护的作用优势明显。
Objective To explore the feasibility and clinical outcome of lateral cervical incision via sternocleidomastoid intermuscular approach(SMIA)in the treatment of primary hyperparathyroidism.Methods The clinical data of 64 patients with primary hyperparathyroidism who underwent unilateral parathyroid surgery in the First Affiliated Hospital,School of Medicine of Zhejiang University from January 2019 to June 2022 were retrospectively analyzed.They were divided into lateral cervical incision via sternocleidomastoid intermuscular approach group(SMIA group)and linea alba cervicalis approach group(LACA group)based on the surgical incision and access route.The differences in clinical features,surgery-related outcomes and postoperative functions of the anterior cervical region were compared between the two groups.The EQ-5D-5L scale was used to assess the subjective feeling of postoperative neck discomfort,while the Hollander Wound Assessment Scale was used to assess the clinical outcome of incision healing.Results There were no statistical differences between the two groups of patients in terms of age,gender,intraoperative bleeding,parathyroid hormone or blood calcium levels before and after surgery(P>0.05).The duration of surgery was significantly shorter in the SMIA group than in the LACA group[(39.77±5.69)min vs.(54.41±4.66)min].There was a statistical difference between the two groups in functional protection of the anterior cervical region at 1 month and 12 months after surgery(1 month,84.67±3.74 vs.79.47±5.38,P<0.001;12 months,93.80±2.52 vs.89.94±2.39,P<0.001),and the SMIA group was better than the LACA group.The Hollander Incision Assessment Scale scores of the SMIA group were better than those of the LACA group at 6 months and 12 months after surgery,and the difference was statistically significant(6 months,1.93±0.58 vs.2.41±0.66,P=0.003;12 months,1.03±0.67 vs.1.74±0.62,P<0.001).Conclusion Parathyroidectomy via sternocleidomastoid intermuscular approach through lateral cervical incision is a simple,safe and effective surgical procedure,which makes it easier to search for parathyroid lesions and shortens the surgical time compared with the traditional incision,and has obvious advantages in the protection of anterior cervical region function.
作者
朱峰
邬一军
沈亦斌
周雪羽
潘俊
陈凌慧
朱丽娴
何琦文
ZHU Feng;WU Yijun;SHEN Yibin;ZHOU Xueyu;PAN Jun;CHEN Linghui;ZHU Lixian;HE Qiwen(Thyroid Center,the First Affiliated Hospital of Zhejiang University,Hangzhou 310003,China)
出处
《西安交通大学学报（医学版）》
CSCD
北大核心
2024年第1期69-73,共5页
Journal of Xi’an Jiaotong University（Medical Sciences）
关键词
颈侧方切口
胸锁乳突肌肌间入路
甲状旁腺手术
颈前区功能保护
lateral neck incision
sternocleidomastoid intermuscular approach
parathyroidectomy
anterior cervical function protection
