中国普外基础与临床杂志

中国普外基础与临床杂志

应用精细化被膜解剖技术经颈入路切除型胸骨后甲状腺肿 75 例临床分析

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目的 探讨精细化被膜解剖技术经颈入路切除Ⅰ型胸骨后甲状腺肿的临床价值。 方法 回顾性分析 2013 年 4 月至 2017 年 4 月期间湖北省孝感市中心医院普外科收治的 75 例Ⅰ型胸骨后甲状腺肿患者的临床资料,采用超声刀及双极电凝镊行精细化被膜解剖经颈入路切除Ⅰ型胸骨后甲状腺肿。 结果 桥本甲状腺炎12例,甲状腺腺瘤10例,结节性甲状腺肿 41 例,甲状腺癌 12 例。行单侧甲状腺全切除术 5 例;双侧甲状腺全切除术 58 例;12 例甲状腺癌患者中 9 例行双侧甲状腺全切除术+中央区淋巴结清扫,3 例行双侧甲状腺全切除术+中央区淋巴结清扫+患侧颈侧区淋巴结清扫。本组患者手术时间平均为 100 min,术中出血量平均为 50 mL,术后住院时间平均为 5 d。术后无出血及皮下积液的发生。发生气管部分软化 2 例。术后平均随访时间 30 个月;随访 72 例,失访 3 例,随访期间无死亡患者,无肿瘤复发、转移患者。 发生甲状腺旁腺损伤 2 例(2.7%),因甲状旁腺损伤导致暂时性低钙血症 2 例(2.7%),发生单侧喉返神经损伤 3 例(4.0%),发生喉上神经外支损伤 1 例(1.3%)。 结论 本组病例的分析结果提示,采用超声刀及双极电凝镊行精细化被膜解剖经颈入路切除术治疗Ⅰ型胸骨后甲状腺肿是安全、可行的,能减少甲状腺切除术的并发症,可有效地保留甲状旁腺及功能,保护喉返神经及喉上神经。

Objective To assess clinical value of thyroidectomy by meticulous capsular dissection technique through neck incision approach in treatment of 75 patients with type Ⅰ substernal goiter. Methods The clinical data of 75 patients with type Ⅰ substernal goiter in the Department of General Surgery of the Central Hospital of Xiaogan from April 2013 to April 2017 were retrospectively analyzed. These patients received the surgical resection by the meticulous capsular dissection technique with an ultrasonic scalpel and a bipolar coagulation forcep through neck incision approach. Results There were 12 Hashimoto thyroiditis, 10 thyroid adenoma, 41 nodular goiter, and 12 thyroid carcinoma in the 75 patients with type Ⅰ substernal goiter. Five cases underwent the unilateral total thyroidectomy. Fifty-eight cases underwent the bilateral total thyroidectomy. The bilateral total thyroidectomy plus central lymph node dissection were performed in the 9 patients with thyroid carcinoma, the bilateral total thyroidectomy plus central lymph node dissection plus affected ipsilateral neck lymph node dissection were performed in the 3 patients with thyroid carcinoma. The average operative time was 100 min, the average intraoperative blood loss was 50 mL, the average postoperative hospital stay was 5 d. The rate of parathyroid injury was 2.7% (2/75), the rate of hypocalcemia caused by parathyroid injury was 2.7% (2/75). There were 3 cases (4.0%) of unilateral recurrent laryngeal nerve injury, 1 case (1.3%) of the outer branch of the upper laryngeal nerve injury. There were 2 cases of tracheal partial softening in the 75 patients. None of postoperative bleeding and seroma happened. No death and the tumor recurrence and metastasis of patients happened during follow-up period. Conclusions Preliminary results in this study show that operation of meticulous capsular dissection technique with an ultrasonic scalpel and a bipolar coagulation forcep through neck incision approach in treatment of type Ⅰ substernal goiter is safe and feasible, it could effectively reduce postoperative complications of thyroidectomy, and protect parathyroid and it’s function, recurrent laryngeal nerve, and superior laryngeal nerve.

关键词: 甲状腺切除术; 喉返神经; 喉上神经; 甲状旁腺; Ⅰ型胸骨后甲状腺肿; 超声刀; 双极电凝镊

Key words: thyroidectomy; recurrent laryngeal nerve; superior laryngeal nerve; parathyroid gland; type Ⅰ substernal goiter; ultrasonic scalpel; bipolar coagulation forcep

引用本文: 余幼林, 胡超华, 沈雄山, 韩运涛, 李卫民, 沈浩元, 彭东杰, 徐元兵. 应用精细化被膜解剖技术经颈入路切除型胸骨后甲状腺肿 75 例临床分析 . 中国普外基础与临床杂志, 2018, 25(2): 184-190. doi: 10.7507/1007-9424.201708002 复制

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