胸锁乳突肌外侧径路在分化型甲状腺癌侧颈部淋巴结清扫中的应用研究

发布时间：2018-08-17 18:47

【摘要】：目的:探讨胸锁乳突肌外侧径路和传统手术方式对于分化型甲状腺癌侧颈部淋巴结清扫范围的达标率、手术时间、住院时间、切口长度、术中出血量、术后引流量,术后引流时间、术后切口满意度、术后并发症及术后局部复发等方面的应用价值。方法:回顾性研究,选取我科在2014年9月至2016年9月期间接诊入院的患者,术前超声检查或者术前行FNAB诊断提示甲状腺癌合并侧颈部淋巴结肿大且术中快速病理报告确定的分化型甲状腺癌患者40例,随机分为对照组和实验组各20例,观察20例甲状腺癌患者在甲状腺癌根治术及侧颈部淋巴结清扫术中采用胸锁乳突肌外侧径路(实验组)和20例甲状腺癌患者在甲状腺癌根治术及侧颈部淋巴结清扫术中采用传统手术方式(对照组)的侧颈部淋巴结清扫范围达标率、手术时间、住院时间、切口长度、术中出血量、术后引流量,术后引流时间、术后切口满意度、术后并发症及术后局部复发等的发生率。结果:(1)实验组手术中对II、III、IV、V区淋巴结清扫数目分别为(2.35±1.07)个、(3.32±1.25)个、(3.04±1.95)个、(2.11±1.74)个。对照组手术中对II、III、IV、V区淋巴结清扫数目分别为(2.49±1.37)个、(3.67±1.04)个、(3.12±1.87)个、(2.09±1.97)个。实验组对于分化型甲状腺癌侧颈部各区淋巴结清扫数目与对照组各区数目分别比较,其P值均大于0.05,差异无统计学意义。实验组中央区淋巴结清扫的数目为(5.24±2.89)个和对照组中央区淋巴结清扫数目(5.04±2.77)个相比较,P0.05,差异无统计学意义。(2)手术时间:实验组手术时间为(45.25±12.35)min,显著低于对照组(65.15±14.35)min。两组比较P0.05,差异有统计学意义。(3)住院时间:实验组住院时间为(3.26±1.83)d,显著低于对照组(5.76±2.58)d。两组比较P0.05,差异有统计学意义。(4)切口长度:实验组切口长度为(6.75±1.63)cm,显著低于对照组(10.37±3.41)cm。两组比较P0.05,差异有统计学意义。(5)术中出血量:实验组术中出血量为(26.78±5.89)ml,显著低于对照组(32.37±16.98)ml。两组比较P0.05,差异有统计学意义。(6)术后引流量:实验组术后总引流量为(80.55±21.37)ml,显著低于对照组(142.78±17.66)ml。两组比较P0.05,差异有统计学意义。(7)术后引流时间:实验组为(3.05±1.24)d,显著低于对照组(5.15±1.56)d。两组比较P0.05,差异有统计学意义。(8)术后切口满意度:实验组患者非常满意17例,满意2例,不满意1例。对照组患者非常满意10例,满意8例,不满意2例。实验组中对切口非常满意和满意的患者数目与对照组中对切口非常满意和满意的患者数目分别比较,其P值均小于0.05,差异有统计学意义。对于患者中对切口不满意方面,实验组和对照组比较P0.05,差异无统计学意义。(9)术后并发症:患者术后出现的并发症主要包括术后出血、切口感染、面部水肿、颈丛神经损伤、膈肌麻痹、霍纳综合征、肩臂综合征、乳糜漏、暂时性喉上神经损伤、暂时性喉返神经损伤、暂时性甲状旁腺损伤和永久性甲状旁腺损伤、暂时性低钙血症和永久性低钙血症。其中对于切口感染和面部水肿两项并发症,实验组和对照组分别比较,其P值均小于0.05,差异有统计学意义。但其余并发症两组分别比较其P值均大于0.05,差异无统计学意义。(10)术后局部复发:实验组术后在随访过程中有2例患者出现区域淋巴结复发,对照组术后在随访过程中有1例患者出现区域淋巴结复发,两组比较P0.05,差异无统计学意义。两组患者在随访过程中均未出现局部复发,两组比较P0.05.差异无统计学意义。结论:胸锁乳突肌外侧径路在分化型甲状腺癌侧颈部淋巴结清扫与传统手术方式相比具有明显的优势,不仅可以达到根治的目的,而且缩短手术时间及住院时间,减小切口长度使得外观更加美观,减少术中出血及术后总引流量,降低术后切口感染和面部水肿等并发症的发生,明显改善患者的生活质量。
[Abstract]:Objective: To investigate the application of lateral sternocleidomastoid muscle approach and traditional surgical methods in the range of neck lymph node dissection, operative time, hospital stay, incision length, intraoperative bleeding volume, postoperative drainage time, postoperative incision satisfaction, postoperative complications and local recurrence of differentiated thyroid carcinoma. Methods: A retrospective study was conducted. Forty patients with differentiated thyroid carcinoma who were admitted to our department from September 2014 to September 2016 were randomly divided into two groups: control group and experimental group, 20 cases in each group. 20 patients with thyroid cancer underwent radical thyroidectomy and lateral cervical lymphadenectomy using the lateral sternocleidomastoid muscle approach (experimental group) and 20 patients with thyroid cancer underwent radical thyroidectomy and lateral cervical lymphadenectomy using the traditional method (control group) of lateral cervical lymphadenectomy reaching the standard rate. Results: (1) In the experimental group, the number of lymph node dissections in II, III, IV and V regions were (2.35 1.07), (3.32 1.25), (3.04 1.95) and (2.11 1.74) respectively. In the control group, the number of lymph node dissection in the II, III, IV and V regions was (2.49 (+ 1.37)), (3.67 (+ 1.04)), (3.12 (+ 1.87)), (2.09 (+ 1.97)) respectively. The number of lymph node dissection in the experimental group was higher than that in the control group, and the difference was not statistically significant. Compared with the control group, the number of lymph node dissection in the central area was (5.24 [2.89] and (5.04 [2.77] respectively. There was no significant difference between the two groups (P 0.05). (2) Operation time: The operation time in the experimental group was (45.25 [12.35] minutes, significantly lower than that in the control group (65.15 [14.35] minutes). There was a significant difference between the two groups (P 0.05). (3) Hospitalization time: The length of incision in the experimental group was (6.75 (1.63) cm, which was significantly lower than that in the control group (10.37 (3.41) cm. There was a significant difference between the two groups (P 0.05). 6.78 [5.89] ml, significantly lower than the control group (32.37 [16.98] ml). There was significant difference between the two groups (P 0.05). (6) Postoperative drainage: The total drainage in the experimental group was (80.55 [21.37] ml, significantly lower than that in the control group (142.78 [17.66] ml). (7) Postoperative drainage time in the experimental group was (3.05 [1.24] d, significantly lower than that in the control group (P 0.05]. Compared with the control group (5.15 + 1.56) days, the difference was statistically significant (P 0.05). (8) Postoperative incision satisfaction: 17 patients in the experimental group were very satisfied, 2 patients were satisfied, 1 patient was unsatisfied. 10 patients in the control group were very satisfied, 8 patients were satisfied, 2 patients were unsatisfied. There was no significant difference between the experimental group and the control group (P 0.05). (9) Postoperative complications: postoperative complications included postoperative bleeding, incision infection, facial edema, cervical plexus and nerves. After injury, diaphragmatic paralysis, Horner syndrome, Shoulder-Arm syndrome, chylorrhea, temporary superior laryngeal nerve injury, temporary recurrent laryngeal nerve injury, temporary parathyroid gland injury and permanent parathyroid gland injury, temporary hypocalcemia and permanent hypocalcemia. For two complications of incision infection and facial edema, the experimental group and the control group There was no significant difference in P value between the two groups. (10) Postoperative local recurrence: 2 patients in the experimental group had regional lymph node recurrence during follow-up, and 1 patient had regional recurrence in the control group during follow-up. There was no significant difference in lymph node recurrence between the two groups (P In order to achieve the goal of radical cure, shorten the operation time and hospitalization time, reduce the length of incision to make the appearance more beautiful, reduce intraoperative bleeding and postoperative total drainage, reduce postoperative incision infection and facial edema and other complications, significantly improve the quality of life of patients.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.1

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