本文選題：腔鏡 + 胸乳入路　； 參考：《福建醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:探討全腔鏡胸乳入路術(shù)式較傳統(tǒng)開(kāi)放術(shù)式在甲狀腺手術(shù)中對(duì)甲狀旁腺辨識(shí)及其功能保護(hù)的優(yōu)勢(shì)及劣勢(shì)。方法:回顧性分析2014年1月至2014年12月期間福建醫(yī)科大學(xué)附屬協(xié)和醫(yī)院甲狀腺外科行全腔鏡胸乳入路術(shù)式全甲狀腺切除+中央?yún)^(qū)淋巴結(jié)清掃術(shù)病例35例,同期行傳統(tǒng)開(kāi)放術(shù)式全甲狀腺切除術(shù)+中央?yún)^(qū)淋巴結(jié)清掃術(shù)病例38例,比較2組術(shù)式之間術(shù)前及術(shù)后第l天、第3天血清甲狀旁腺激素(parathyroid hormone,PTH)及血清鈣離子(Ca2+)濃度及其變化;同時(shí)比較2組術(shù)式之間術(shù)中對(duì)甲狀旁腺的辨識(shí)個(gè)數(shù),術(shù)后甲狀旁腺病理檢出率,術(shù)后一過(guò)性,永久性甲狀旁腺功能減退癥的發(fā)生率以及術(shù)后病理檢出的中央?yún)^(qū)淋巴結(jié)清掃個(gè)數(shù)之間的差異。結(jié)果:2組之間在性別、年齡、術(shù)前甲狀旁腺激素(PTH)濃度、術(shù)前血鈣(Ca2+)濃度上的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。全腔鏡胸乳入路術(shù)式組術(shù)中對(duì)甲狀旁腺的辨識(shí)個(gè)數(shù)(3.30±0.70)高于開(kāi)放術(shù)式組(2.86±0.71),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后甲狀旁腺病理檢出率(2/35)低于開(kāi)放術(shù)式組(12/38),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后第1天、第3天測(cè)得的2組的血清甲狀旁腺激素(PTH)濃度均有明顯下降,其中全腔鏡術(shù)式組術(shù)后第1天PTH水平(1.05±0.80)pmol/L,開(kāi)放術(shù)式組術(shù)后第1天PTH水平(0.57±0.54)pmol/L,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。全腔鏡術(shù)式組術(shù)后第3天PTH水平(1.37±0.70)pmol/L,開(kāi)放術(shù)式組術(shù)后第3天PTH水平(0.81±0.70)pmol/L,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。全腔鏡胸乳入路術(shù)式組一過(guò)性(9/35)甲狀旁腺減退者相對(duì)開(kāi)放術(shù)式組(27/38)少,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。腔鏡術(shù)式組(0/35)與傳統(tǒng)開(kāi)放術(shù)式組(0/38)永久性甲狀旁腺功能減退癥的發(fā)生率均為0,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2組術(shù)后病理檢出單/雙側(cè)中央?yún)^(qū)淋巴結(jié)清掃數(shù)比較中,全腔鏡術(shù)式組的單側(cè)中央?yún)^(qū)淋巴結(jié)清掃個(gè)數(shù)(11.52±5.36)較開(kāi)放術(shù)式組(7.43±3.50)多,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。全腔鏡術(shù)式組的雙側(cè)中央?yún)^(qū)淋巴結(jié)清掃個(gè)數(shù)(15.60±6.60)較開(kāi)放術(shù)式組(10.96±5.70)多,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:全腔鏡胸乳入路全甲狀腺切除+中央?yún)^(qū)淋巴結(jié)清掃術(shù)是一種安全的手術(shù)方法,與傳統(tǒng)開(kāi)放術(shù)式比較,它能減少手術(shù)對(duì)甲狀旁腺及其功能的影響,有利于甲狀旁腺功能的保護(hù)和恢復(fù),較開(kāi)放術(shù)式更具有優(yōu)勢(shì)。
[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.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R653

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