RESUMEN
Objective:To investigate the effect of fine anatomy combined with exposure of recurrent laryngeal nerve in cricothyroid space in differentiated thyroid cancer surgery.Methods:Sixty patients with differentiated thyroid cancer who received treatment in Ningbo Hospital of Traditional Chinese Medicine from January 2017 to April 2020 were included in this study. They were randomly assigned to receive either fine anatomy combined with exposure of recurrent laryngeal nerve in cricothyroid space (observation group, n = 30) or routine surgery + inferior thyroid artery exposure of recurrent laryngeal nerve (control group, n = 30). Operative time, the volume of intraoperative blood loss, and the number of lymph node dissected were compared between the two groups. Parathyroid hormone (PTH) and blood calcium (Ca 2+) concentrations in the two groups were determined. The adverse reactions such as recurrent laryngeal nerve and parathyroid injury were observed in each group. Results:Operative time, the volume of intraoperative blood loss, and the number of lymph node dissected in the observation group were (71.28 ± 10.08) minutes, (16.69 ± 4.65) mL, and (4.78 ± 1.26), respectively, which were significantly different from those in the control group [(69.27 ± 11.89) minutes, (17.14 ± 4.52) mL, (4.76 ± 1.22), t = 0.706, 0.380, 0.062, all P > 0.05]. Before surgery, there were no significant differences in PTH and Ca 2+ concentrations between the two groups [PTH: (50.24 ± 11.21) g/L vs. (50.21 ± 11.19) g/L; Ca 2+: (2.18 ± 0.08) mmol/L vs. (2.17 ± 0.09) mmol/L, t = 0.010, 0.454, both P > 0.05]. After surgery, PTH and Ca 2+ concentrations in the observation group were significantly higher than those in the control group [PTH: [(31.44 ± 6.09) g/L vs. (16.57 ± 2.35) g/L; Ca 2+: (2.07 ± 0.10) mmol/L vs. (1.23 ± 0.12) mmol/L, t = 12.477, 29.454, both P < 0.01]. Total incidence of adverse reactions in the observation group was significantly lower than that in the control group [10.00% (3/30) vs. 46.67% (14/30), χ2 = 9.931, P < 0.01). Conclusion:Application of fine anatomy combined with exposure of recurrent laryngeal nerve in cricothyroid space in differentiated thyroid cancer surgery is highly effective in the clinic. Accurate identification of recurrent laryngeal nerve in cricothyroid space is helpful to preserve the parathyroid gland and blood supply in situ, leads to a small range of changes in PTH and Ca 2+ concentrations, reduces postoperative complications, so as to protect the recurrent laryngeal nerve and parathyroid gland and thereby promote postoperative recovery.
RESUMEN
Objective@#To explore the protective effect of refined anatomy on parathyroid glands in double thyroid cancer surgery.@*Methods@#From January 2012 to December 2017, 31 patients with bilateral thyroid cancer who underwent bilateral total thyroidectomy plus bilateral central lymph node dissection in Lanxi People's Hospital were selected in the study.According to the different admission time, they were divided into 14 cases in the control group (traditional thyroidectomy) and 17 cases in the observation group (fine capsular dissection). The duration of operation, the amount of intraoperative blood loss, the drainage volume at 1 day after surgery, the retention of parathyroid glands, the changes of serum calcium and parathyroid hormone levels, and the decline of thyroid function were compared between the two groups.@*Results@#The intraoperative blood loss and the 1d drainage volume in the observation group were less than those in the control group [(51.25±23.13)mL vs.(74.62±24.58)mL, (52.71±12.47)mL vs.(63.48±15.69)mL](t=2.722, 2.131, all P<0.05). At 7 days after operation, the parathyroid hormone and serum calcium levels in the observation group were significantly higher than those in the control group[(24.21±10.46)mg/L vs.(16.18±10.57)mg/L, (2.01±0.12)mmol/L vs.(1.89±0.11)mmol/L] (t=2.117, 2.876, all P<0.05). During operation, 31 parathyroid glands were detected in the control group, average (2.6±0.3), 47 parathyroid glands were detected in the observation group, average (3.1±0.4), the difference between the two groups was statistically significant (t=3.863, P<0.05). The transient and permanent parathyroid function decline rates of the control group were 71.4% (10/14) and 7.1% (1/14), which of the observation group were 52.9% (9/17) and 0.0% (0/17).@*Conclusion@#In bilateral thyroid cancer surgery, the application of refined anatomy can effectively avoid miscuting the parathyroid glands and protect the parathyroid function, which is worthy of clinical promotion.
RESUMEN
Objective To explore the protective effect of refined anatomy on parathyroid glands in double thyroid cancer surgery.Methods From January 2012 to December 2017,31 patients with bilateral thyroid cancer who underwent bilateral total thyroidectomy plus bilateral central lymph node dissection in Lanxi People's Hospital were selected in the study.According to the different admission time,they were divided into 14 cases in the control group (traditional thyroidectomy) and 17 cases in the observation group (fine capsular dissection).The duration of operation,the amount of intraoperative blood loss,the drainage volume at 1 day after surgery,the retention of parathyroid glands,the changes of serum calcium and parathyroid hormone levels,and the decline of thyroid function were compared between the two groups.Results The intraoperative blood loss and the 1 d drainage volume in the observation group were less than those in the control group [(51.25 ± 23.13) mL vs.(74.62 ± 24.58) mL,(52.71 ± 12.47) mL vs.(63.48 ± 15.69) mL] (t =2.722,2.131,all P ＜ 0.05).At 7 days after operation,the parathyroid hormone and serum calcium levels in the observation group were significantly higher than those in the control group[(24.21 ± 10.46)mg/L vs.(16.18 ± 10.57)mg/L,(2.01 ±0.12)mmol/L vs.(1.89 ±0.11) mmol/L] (t =2.117,2.876,all P ＜0.05).During operation,31 parathyroid glands were detected in the control group,average (2.6 ± 0.3),47 parathyroid glands were detected in the observation group,average (3.1 ± 0.4),the difference between the two groups was statistically significant (t =3.863,P ＜ 0.05).The transient and permanent parathyroid function decline rates of the control group were 71.4％ (10/14) and 7.1％ (1/14),which of the observation group were 52.9％ (9/17) and 0.0％ (0/17).Conclusion In bilateral thyroid cancer surgery,the application of refined anatomy can effectively avoid miscuting the parathyroid glands and protect the parathyroid function,which is worthy of clinical promotion.