甲状腺系膜切除术在中央区淋巴结清扫的临床研究

目的探讨甲状腺乳头状癌(PTC)患者行甲状腺系膜切除术的中央区淋巴结清扫的临床价值。方法回顾性分析2017年10月至2019年4月173例PTC患者临床资料。根据术式不同分为两组,常规组98例,术中行常规中央区淋巴结清扫;系膜组75例,术中行甲状腺系膜切除术清扫中央区淋巴结。使用统计软件SPSS 24.0分析,围术期指标、甲状旁腺素(PTH)、血钙等计量资料采用(±s)表示,独立样本t检验;术后并发症、复发转移率等计数资料采用χ²检验。以P<0.05差异有统计学意义。结果两组患者在手术时间、术中出血量、术后住院时间及中央区淋巴结清扫数目中差异均无统计学意义(P>0.05);两组患者术后3 d PTH及血钙水平均较术前明显下降,且常规组较系膜组均更低(P<0.05);常规组术后并发症发生率为20.4%明显高于系膜组9.3%(P<0.05);术后平均随访12.7个月,术后3个月内,所有患者PTH均恢复正常,无永久性喉返神经损伤及永久性甲状旁腺功能低下发生。随访期内常规组复发转移率为5.1%,系膜组为2.7%,差异无统计学意义(P>0.05)。结论在PTC手术中,通过甲状腺系膜切除术清扫中央区淋巴结,具有手术并发症发生率低,更好地保护甲状旁腺功能,避免血钙水平过度下降的优势。

Clinical study of total mesangyroidectomy in central lymph node dissection

Objective To explore the clinical value of central lymph node dissection in patients with papillary thyroid carcinoma(PTC)undergoing mesyroidectomy.Method The clinical data of 173 PTC patients from October 2017 to April 2019 were collected.According to different surgical methods,they were divided into 2 groups,the conventional group(n=98)underwent routine central lymph node dissection,75 patients underwent mesangyroidectomy to dissect central lymph nodes.SPSS 24.0 software was used for data analysis of perioperative indicators,PTH,blood calcium and other measurement data were represented by.Independent sample t test.The counting data of postoperative complications,recurrence and metastasis rate were measured byχ² test.P<0.05 was considered statistically significant.Results There was no significant difference between the two groups in operation time,intraoperative blood loss,postoperative hospital stay and the number of central lymph node dissection(P>0.05).The mean postoperative follow-up was 12.7 months,and PTH and of all patients returned to normal within 3 months after the operation,without permanent recurrent laryngeal nerve injury or permanent hypoparathyroidism.During the follow-up period,the recurrence and metastasis rate of the conventional group was 5.1%,and that of the mesangial group was 2.7%,with no statistically significant difference(P>0.05).ConclusionIn the PTC surgery,central lymph node dissection through thyroid mesangial resection has the advantage of low incidence of surgical complications,better protection of parathyroid function,and avoiding excessive decrease of blood calcium level.