【摘要】：目的:探討胸鎖乳突肌外側徑路和傳統(tǒng)手術方式對于分化型甲狀腺癌側頸部淋巴結清掃范圍的達標率、手術時間、住院時間、切口長度、術中出血量、術后引流量,術后引流時間、術后切口滿意度、術后并發(fā)癥及術后局部復發(fā)等方面的應用價值。方法:回顧性研究,選取我科在2014年9月至2016年9月期間接診入院的患者,術前超聲檢查或者術前行FNAB診斷提示甲狀腺癌合并側頸部淋巴結腫大且術中快速病理報告確定的分化型甲狀腺癌患者40例,隨機分為對照組和實驗組各20例,觀察20例甲狀腺癌患者在甲狀腺癌根治術及側頸部淋巴結清掃術中采用胸鎖乳突肌外側徑路(實驗組)和20例甲狀腺癌患者在甲狀腺癌根治術及側頸部淋巴結清掃術中采用傳統(tǒng)手術方式(對照組)的側頸部淋巴結清掃范圍達標率、手術時間、住院時間、切口長度、術中出血量、術后引流量,術后引流時間、術后切口滿意度、術后并發(fā)癥及術后局部復發(fā)等的發(fā)生率。結果:(1)實驗組手術中對II、III、IV、V區(qū)淋巴結清掃數(shù)目分別為(2.35±1.07)個、(3.32±1.25)個、(3.04±1.95)個、(2.11±1.74)個。對照組手術中對II、III、IV、V區(qū)淋巴結清掃數(shù)目分別為(2.49±1.37)個、(3.67±1.04)個、(3.12±1.87)個、(2.09±1.97)個。實驗組對于分化型甲狀腺癌側頸部各區(qū)淋巴結清掃數(shù)目與對照組各區(qū)數(shù)目分別比較,其P值均大于0.05,差異無統(tǒng)計學意義。實驗組中央?yún)^(qū)淋巴結清掃的數(shù)目為(5.24±2.89)個和對照組中央?yún)^(qū)淋巴結清掃數(shù)目(5.04±2.77)個相比較,P0.05,差異無統(tǒng)計學意義。(2)手術時間:實驗組手術時間為(45.25±12.35)min,顯著低于對照組(65.15±14.35)min。兩組比較P0.05,差異有統(tǒng)計學意義。(3)住院時間:實驗組住院時間為(3.26±1.83)d,顯著低于對照組(5.76±2.58)d。兩組比較P0.05,差異有統(tǒng)計學意義。(4)切口長度:實驗組切口長度為(6.75±1.63)cm,顯著低于對照組(10.37±3.41)cm。兩組比較P0.05,差異有統(tǒng)計學意義。(5)術中出血量:實驗組術中出血量為(26.78±5.89)ml,顯著低于對照組(32.37±16.98)ml。兩組比較P0.05,差異有統(tǒng)計學意義。(6)術后引流量:實驗組術后總引流量為(80.55±21.37)ml,顯著低于對照組(142.78±17.66)ml。兩組比較P0.05,差異有統(tǒng)計學意義。(7)術后引流時間:實驗組為(3.05±1.24)d,顯著低于對照組(5.15±1.56)d。兩組比較P0.05,差異有統(tǒng)計學意義。(8)術后切口滿意度:實驗組患者非常滿意17例,滿意2例,不滿意1例。對照組患者非常滿意10例,滿意8例,不滿意2例。實驗組中對切口非常滿意和滿意的患者數(shù)目與對照組中對切口非常滿意和滿意的患者數(shù)目分別比較,其P值均小于0.05,差異有統(tǒng)計學意義。對于患者中對切口不滿意方面,實驗組和對照組比較P0.05,差異無統(tǒng)計學意義。(9)術后并發(fā)癥:患者術后出現(xiàn)的并發(fā)癥主要包括術后出血、切口感染、面部水腫、頸叢神經(jīng)損傷、膈肌麻痹、霍納綜合征、肩臂綜合征、乳糜漏、暫時性喉上神經(jīng)損傷、暫時性喉返神經(jīng)損傷、暫時性甲狀旁腺損傷和永久性甲狀旁腺損傷、暫時性低鈣血癥和永久性低鈣血癥。其中對于切口感染和面部水腫兩項并發(fā)癥,實驗組和對照組分別比較,其P值均小于0.05,差異有統(tǒng)計學意義。但其余并發(fā)癥兩組分別比較其P值均大于0.05,差異無統(tǒng)計學意義。(10)術后局部復發(fā):實驗組術后在隨訪過程中有2例患者出現(xiàn)區(qū)域淋巴結復發(fā),對照組術后在隨訪過程中有1例患者出現(xiàn)區(qū)域淋巴結復發(fā),兩組比較P0.05,差異無統(tǒng)計學意義。兩組患者在隨訪過程中均未出現(xiàn)局部復發(fā),兩組比較P0.05.差異無統(tǒng)計學意義。結論:胸鎖乳突肌外側徑路在分化型甲狀腺癌側頸部淋巴結清掃與傳統(tǒng)手術方式相比具有明顯的優(yōu)勢,不僅可以達到根治的目的,而且縮短手術時間及住院時間,減小切口長度使得外觀更加美觀,減少術中出血及術后總引流量,降低術后切口感染和面部水腫等并發(fā)癥的發(fā)生,明顯改善患者的生活質量。
[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.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R736.1

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