甲状腺联合系膜整块切除在甲状腺癌根治术中的应用

doi:10.3969/j.issn.10056483.2019.02.017

摘要/Abstract

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。

关键词: 甲状腺癌, 系膜, 喉返神经, 甲状旁腺

Abstract: 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 was 5.6±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.

Key words: thyroid cancer, mesangial, ecurrent laryngeal nerve, parathyroid gland

叶亮, 孙科, 张超, 刘立平, 刘细平, 徐绍忠. 甲状腺联合系膜整块切除在甲状腺癌根治术中的应用[J]. 临床外科杂志, 2019, 27(2): 138-141.

参考文献

相关文章 15

[1]	文妍, 黄家辉, 陆瑶瑶, 马朝群, 张传灼. 乳腺癌术后伴原发甲状腺癌17例[J]. 临床外科杂志, 2019, 27(3): 212-213.
[2]	李兴睿, 徐滔. 美国癌症联合委员会第8版分化型甲状腺癌TNM分期更新解读[J]. 临床外科杂志, 2019, 27(1): 33-35.
[3]	赵英杰张荷焕. 甲状腺癌合并乳腺癌一例[J]. 临床外科杂志, 2018, 26(9): 719-719.
[4]	刘胜新吴兰艳徐军辉李震. 精细膜解剖技术在甲状腺手术中的应用体会（附211例报告）[J]. 临床外科杂志, 2018, 26(11): 839-841.
[5]	喻希高磊谢森伍依依潘铁军. 原发性肾上腺淋巴瘤一例[J]. 临床外科杂志, 2018, 26(11): 890-890.
[6]	杜晓辉何长征. 右半结肠癌微创治疗的术式选择[J]. 临床外科杂志, 2018, 26(10): 724-726.
[7]	张辉亮庄競. 腹腔镜结直肠外科膜解剖的再认识[J]. 临床外科杂志, 2018, 26(10): 731-732.
[8]	韩伟峰费伯健曹华祥等. 完整结肠系膜切除在中间入路右半结肠癌D3根治术中的临床应用 [J]. 临床外科杂志, 2013, 21(5): 360-362.
[9]	丁乾伍钢. 分化型甲状腺癌的放射治疗[J]. 临床外科杂志, 2012, 20(7): 523-524.
[10]	金留根费伯健王卫理等. 右半结肠癌根治术中完整结肠系膜切除与传统方法对比研究[J]. 临床外科杂志, 2012, 20(7): 480-482.
[11]	石磊陈平何春兰等. 甲状腺手术中显露喉返神经的安全性探讨[J]. 临床外科杂志, 2012, 20(7): 471-472.
[12]	李涛张平刘冰阳等. 甲状腺术后症状性低钙血症与甲状旁腺激素及血钙关系的探讨[J]. 临床外科杂志, 2012, 20(7): 467-468.
[13]	孙圣荣许志亮. 甲状腺癌甲状腺全切除术的适应证[J]. 临床外科杂志, 2012, 20(7): 457-458.
[14]	刘运江;王学良;刘北辰. 甲状腺结节细针穿刺细胞学检查的临床价值 [J]. 临床外科杂志, 2012, 20(7): 453-454.
[15]	陈德杰廖晓锋汪江平. 急性肠系膜上动脉缺血16例临床分析[J]. 临床外科杂志, 2012, 20(6): 407-407.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed