摘要
目的探讨甲状腺联合系膜整块切除在甲状腺癌根治术中的应用。方法甲状腺癌病人17例,采用甲状腺联合系膜整块切除术,统计术后并发症(出血、低钙抽搐、声音嘶哑、呛咳)、淋巴结清扫数量、喉返神经显露与保护、甲状旁腺、甲状旁腺素减低等,评估手术安全性及临床疗效。结果 17例病人手术顺利,16例乳头状癌,1例滤泡状癌。术中游离系膜后均全程显露喉返神经,无损伤;术中辨认出A1、A2型甲状旁腺共29枚,均予以保留;系膜中分离并病理证实有6枚B1型甲状旁腺,均行自体移植。病检单侧系膜清扫淋巴结平均(5. 6±2. 1)枚,阳性淋巴结平均(3. 3±1. 2)枚。术中出血(28. 0±5. 6)ml,术后切口引流液(34. 0±7. 6)ml,术后均无声音嘶哑、呛咳;术后有2例暂时性甲状旁腺素降低,经补钙后恢复正常,无永久性甲状旁腺素减低。结论甲状腺联合系膜整块切除术,能快速、全程显露喉返神经,防止损伤;能更彻底清扫中央区淋巴结,有效保护甲状旁腺;手术安全、有效,降低手术难度,提高手术质量,更加符合肿瘤整块切除及无瘤接触原则。
Objective To study the joint mesangial thyroid resection in the application of thyroid cancer radical. Methods A prospective study of hospitalized in our department of 17 patients with thyroid cancer,using joint mesangial block resection of thyroid,statistics postoperative complications( bleeding,low calcium convulsions,voice hoarse,choking cough),number of lymph node cleaning,laryngeal recurrent nerve and protection,parathyroid gland,parathyroid hormone reduce,etc.,to evaluate the safety and clinical efficacy. Results 17 patients had smooth operation,16 cases of papillary carcinoma and 1 case of follicular carcinoma. The recurrent laryngeal nerve was revealed all the way after the free film in the operation,without injury. A total of 29 parathyroid glands of A1 and A2 were identified. Six B1 parathyroid glands were isolated and pathologically confirmed in the film. The average number of lymph nodes was5. 6 ± 2. 1,and the positive lymph node was 3. 3 ± 1. 2. Intraoperative hemorrhage was(28. 0 ± 5. 6) ml,and the incision drainage fluid was(34. 0 ± 7. 6) ml. No hoarseness and cough were observed after the operation. There were 2 cases of temporary parathyroid hormone reduction after operation,and normal after calcium supplementation,and no permanent parathyroid hormone decreased. Conclusion Thyroid joint mesangial block resection,can quickly and show all the laryngeal recurrent nerve,prevent damage;Can be more thoroughly cleaning the lymph node in central region,effectively protect the parathyroid gland;Surgery is safe,effective,reduce the operation difficulty,improve the quality of operation,more in line with the whole piece of tumor resection and disease-free contact principle.
作者
叶亮
孙科
张超
刘立平
刘细平
徐绍忠
YE Liang;SUN Ke;ZHANG Chao(Department of General Surgery,the Center hospital of Zhuzhou City,Hunan province 412000,China)
出处
《临床外科杂志》
2019年第2期138-141,共4页
Journal of Clinical Surgery
关键词
甲状腺癌
系膜
喉返神经
甲状旁腺
thyroid cancer
mesangial
recurrent laryngeal nerve
parathyroid gland
作者简介
第一作者:叶亮;第一作者:孙科
