摘要：
目的 探讨在双侧甲状腺癌手术中应用精细化被膜解剖法对甲状旁腺的保护效果.方法 选择2012年1月至2017年12月兰溪市人民医院行双侧甲状腺全切+双侧中央区淋巴结清扫治疗的双侧甲状腺癌患者31作为研究对象,根据入院时间的不同,分为对照组14例(行传统甲状腺切除)和观察组17例(行精细化被膜解剖),比较两组手术时长、术中出血量、术后1d引流量、甲状旁腺保留情况、血钙和甲状旁腺素水平变化情况、甲状腺功能下降情况.结果 观察组的术中出血量和术后1d引流量少于对照组[(51.25±23.13)mL比(74.62 ±24.58)mL,(52.71±12.47) mL比(63.48±15.69) mL,t=2.722、2.131,均P＜0.05];术后7d,观察组的甲状旁腺素和血钙水平明显高于对照组[(24.21±10.46) mg/L比(16.18±10.57) mg/L,(2.01±0.12) mmol/L比(1.89±0.11) mmol/L,t=2.117、2.876,均P＜0.05);术中,对照组检出甲状旁腺31枚,平均(2.6±0.3)枚,观察组检出47枚,平均(3.1±0.4)枚,两组差异有统计学意义(t=3.863,P＜0.05);对照组一过性和永久性甲状旁腺功能下降率分别为71.4％(10/14)和7.1％ (1/14),观察组的一过性和永久性甲状旁腺功能下降率分别为52.9％ (9/17)和0.0％ (0/17).结论 在双侧甲状腺癌手术中,应用精细化被膜解剖法能有效避免误切甲状旁腺,保护甲状旁腺功能,值得临床推广.%Objective To explore the protective effect of refined anatomy on parathyroid glands in double thyroid cancer surgery.Methods From January 2012 to December 2017,31 patients with bilateral thyroid cancer who underwent bilateral total thyroidectomy plus bilateral central lymph node dissection in Lanxi People's Hospital were selected in the study.According to the different admission time,they were divided into 14 cases in the control group (traditional thyroidectomy) and 17 cases in the observation group (fine capsular dissection).The duration of operation,the amount of intraoperative blood loss,the drainage volume at 1 day after surgery,the retention of parathyroid glands,the changes of serum calcium and parathyroid hormone levels,and the decline of thyroid function were compared between the two groups.Results The intraoperative blood loss and the 1 d drainage volume in the observation group were less than those in the control group [(51.25 ± 23.13) mL vs.(74.62 ± 24.58) mL,(52.71 ± 12.47) mL vs.(63.48 ± 15.69) mL] (t =2.722,2.131,all P ＜ 0.05).At 7 days after operation,the parathyroid hormone and serum calcium levels in the observation group were significantly higher than those in the control group[(24.21 ± 10.46)mg/L vs.(16.18 ± 10.57)mg/L,(2.01 ±0.12)mmol/L vs.(1.89 ±0.11) mmol/L] (t =2.117,2.876,all P ＜0.05).During operation,31 parathyroid glands were detected in the control group,average (2.6 ± 0.3),47 parathyroid glands were detected in the observation group,average (3.1 ± 0.4),the difference between the two groups was statistically significant (t =3.863,P ＜ 0.05).The transient and permanent parathyroid function decline rates of the control group were 71.4％ (10/14) and 7.1％ (1/14),which of the observation group were 52.9％ (9/17) and 0.0％ (0/17).Conclusion In bilateral thyroid cancer surgery,the application of refined anatomy can effectively avoid miscuting the parathyroid glands and protect the parathyroid function,which is worthy of clinical promotion.
