峡部入路在甲状腺手术中的临床研究(1)
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[摘要] 目的 探讨甲状腺手术中峡部入路的临床应用。 方法 将我院2007年8月~2010年8月的229例甲状腺手术患者分为两组。治疗组113例采用峡部入路，对照组116例采用传统入路，均由同一组医生施术。观察记录手术时间、术中出血、术后引流量及术后喉返神经及甲状旁腺损伤情况。 结果 治疗组在上述观察指标上均优于对照组(P <0.05)。 结论 经峡部入路行甲状腺手术可明显缩短手术时间，减少术中出血、术后引流量，降低喉返神经及甲状旁腺损伤的发生率，优于传统甲状腺手术入路。
[关键词] 甲状腺手术；甲状腺疾病；峡部入路；传统入路
[中图分类号] R581 [文献标识码] A [文章编号] 1673-7210(2012)02(c)-0038-02
Clinical research of approach by per-isthmus incisiom for thyroidectomy
ZENG Zhiqin DING Junli WEI Jianbin YANG Yong ZHU Xinfeng
The First Department of Surgery, the People′s Hospital of Lianzhou City, Guangdong Province, Lianzhou 513400, China
[Abstract] Objective To analyze the significance of the approach by per-isthmus incisiom for tryroindectomy. Mehtods 229 patients underwent thyroidectomy from Aug 2007 to Aug 2010 were divided randomly into treatment group and control group. 113 patients of treatment group were treated with aprroach by per-isthmus incisiom for thyroidectomy. 116 patients of control group were treated with traditional approach. All these operations were accomplished by the same team of surgeons. Operation time, intraoperation bleeding volume, postoperative drainage volume and complications were observed. Results In the treatment group, the operation time, intraoperation bleeding volume, postoperative drainage volume and complications were obviously decreased (P <0.05). Conclusion Approach by per-isthmus incisiom for thyroidectomy can obviously decrease operation time, bleeding volume, postoperative drainage volume, injury rate of recurrent laryngeal nerve and parthyroid. It is a better approach than the traditional approach.
[Key words] Thyroidectomy; Thyroid diseases; Per-isthmus incisiom; Traditional approach
传统的甲状腺手术先处理甲状腺血管，再处理峡部。我科在实际工作发现先处理峡部，再进行甲状腺血管的离断及后续手术步骤更符合由易到难的手术分离原则，更利于手术的进行。我科为此设计前瞻性随机性单盲对照试验，比较峡部入路与传统入路在甲状腺手术中的优劣。现报道如下：
1资料与方法
1.1 一般资料
选定2007年8月~2010年8月我科患者中确诊为甲状腺疾病且需手术治疗的229例病例，排除再手术患者、胸骨后甲状腺肿、术前确诊或怀疑甲状腺癌的患者。依据入路方法不同分为治疗组与对照组。治疗组113例，男24例，女89例；年龄18~69岁，平均37岁。其中原发性甲亢13例，结节性甲状腺肿68例，甲状腺腺瘤25例，甲状腺癌7例。一侧次全切或全切加峡部切除37例，双侧次全切或全切75例。对照组116例，男26例，女90例。年龄17~76岁，平均35岁。其中原发性甲亢15 例，结节性甲状腺肿67例，甲状腺腺瘤26例，甲状腺癌8例。一侧次全切或全切加峡部切除40例，双侧次全切或全切76例。两组患者在性别、年龄、疾病分类及手术方式等方面比较 ......
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