全腔镜术式对甲状旁腺及其功能保护的临床研究

发布时间：2018-07-10 12:04

本文选题：腔镜 + 胸乳入路　；参考：《福建医科大学》2015年硕士论文

【摘要】：目的:探讨全腔镜胸乳入路术式较传统开放术式在甲状腺手术中对甲状旁腺辨识及其功能保护的优势及劣势。方法:回顾性分析2014年1月至2014年12月期间福建医科大学附属协和医院甲状腺外科行全腔镜胸乳入路术式全甲状腺切除+中央区淋巴结清扫术病例35例,同期行传统开放术式全甲状腺切除术+中央区淋巴结清扫术病例38例,比较2组术式之间术前及术后第l天、第3天血清甲状旁腺激素(parathyroid hormone,PTH)及血清钙离子(Ca2+)浓度及其变化;同时比较2组术式之间术中对甲状旁腺的辨识个数,术后甲状旁腺病理检出率,术后一过性,永久性甲状旁腺功能减退症的发生率以及术后病理检出的中央区淋巴结清扫个数之间的差异。结果:2组之间在性别、年龄、术前甲状旁腺激素(PTH)浓度、术前血钙(Ca2+)浓度上的差异无统计学意义(P0.05)。全腔镜胸乳入路术式组术中对甲状旁腺的辨识个数(3.30±0.70)高于开放术式组(2.86±0.71),差异有统计学意义(P0.05)。术后甲状旁腺病理检出率(2/35)低于开放术式组(12/38),差异有统计学意义(P0.05)。术后第1天、第3天测得的2组的血清甲状旁腺激素(PTH)浓度均有明显下降,其中全腔镜术式组术后第1天PTH水平(1.05±0.80)pmol/L,开放术式组术后第1天PTH水平(0.57±0.54)pmol/L,差异有统计学意义(P0.05)。全腔镜术式组术后第3天PTH水平(1.37±0.70)pmol/L,开放术式组术后第3天PTH水平(0.81±0.70)pmol/L,差异有统计学意义(P0.05)。全腔镜胸乳入路术式组一过性(9/35)甲状旁腺减退者相对开放术式组(27/38)少,差异有统计学意义(P0.05)。腔镜术式组(0/35)与传统开放术式组(0/38)永久性甲状旁腺功能减退症的发生率均为0,差异无统计学意义(P0.05)。2组术后病理检出单/双侧中央区淋巴结清扫数比较中,全腔镜术式组的单侧中央区淋巴结清扫个数(11.52±5.36)较开放术式组(7.43±3.50)多,差异有统计学意义(P0.05)。全腔镜术式组的双侧中央区淋巴结清扫个数(15.60±6.60)较开放术式组(10.96±5.70)多,差异有统计学意义(P0.05)。结论:全腔镜胸乳入路全甲状腺切除+中央区淋巴结清扫术是一种安全的手术方法,与传统开放术式比较,它能减少手术对甲状旁腺及其功能的影响,有利于甲状旁腺功能的保护和恢复,较开放术式更具有优势。
[Abstract]:Objective: To explore the advantages and disadvantages of total endoscopic thoracoemulsion approach for parathyroid identification and function protection in thyroid surgery. Methods: a retrospective analysis of total thyroidectomy in the thyroid surgery department of the affiliated Concorde Hospital of Fujian Medical University from January 2014 to December 2014. 35 cases of central region lymph node dissection were treated with traditional open operation and 38 cases of central region lymph node dissection. The concentrations and changes of serum parathyroid hormone (parathyroid hormone, PTH) and serum calcium ion (Ca2+) were compared between the 2 groups before and after the operation, and the 2 groups were compared. The number of parathyroid glands, the pathological detection rate of parathyroid glands after operation, the incidence of perpetual hypoparathyroidism after operation, the incidence of permanent parathyroidism and the number of lymph node dissections in the central region after operation. Results: the 2 groups were in sex, age, preoperation parathyroid hormone (PTH) concentration, and preoperative blood calcium (Ca2+) concentration. There was no statistical significance (P0.05). The number of parathyroid glands in the total Endoscopy Group (3.30 + 0.70) was higher than that in the open operation group (2.86 + 0.71). The difference was statistically significant (P0.05). The pathological detection rate of parathyroid gland (2/35) was lower than that of the open operation group (12/38). The difference was statistically significant (P0.05). First days after the operation, the number of parathyroid glands was statistically significant. The concentration of serum parathyroid hormone (PTH) in the 2 groups of the 3 days was significantly decreased, of which the total Endoscopy Group was first days PTH (1.05 + 0.80) pmol/L, and the PTH level was (0.57 + 0.54) pmol/L after the open operation group, and the difference was statistically significant (P0.05). The PTH level was (1.37 + 0.70) pmol/L and open operation third days after the total lumen mirror group operation. The PTH level was (0.81 + 0.70) pmol/L at third days after operation, and the difference was statistically significant (P0.05). The total endoscopy (9/35) parathyroid hypogonadism group was less than the open operation group (27/38), and the difference was statistically significant (P0.05). The Endoscopy Group (0/35) and the traditional open operation group (0/38) perpetual parathyroid hypogonadism The rate of birth was 0, and the difference was not statistically significant (P0.05) in group.2 after operation, the number of lymph node dissections in the unilateral central region was compared with the total Endoscopy Group (11.52 + 5.36) in the unilateral central region of the lymph node (7.43 + 3.50), and the difference was statistically significant (P0.05). The lymph node clearance in the bilateral central region of the total Endoscopy Group The number of scans (15.60 + 6.60) was more than that of open operation group (10.96 + 5.70), and the difference was statistically significant (P0.05). Conclusion: total endoscopic total thyroidectomy with total thyroidectomy and central region lymph node dissection is a safe operation method. Compared with the traditional open operation, it can reduce the effect of operation on parathyroid gland and its function and is beneficial to parathyroid gland. Functional protection and restoration are more advantageous than open surgery.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R653

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