首页|缝线牵引悬吊法在胸乳入路腔镜甲状腺癌根治术中的应用

缝线牵引悬吊法在胸乳入路腔镜甲状腺癌根治术中的应用

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目的 探讨缝线牵引悬吊法在胸乳入路腔镜甲状腺手术中的应用价值。方法 回顾性分析 2020 年 1 月~2022 年12 月108 例甲状腺乳头状癌行胸乳入路腔镜单侧腺叶切除、同侧中央区淋巴结清扫的资料。2021 年5 月后逐步开展用2-0 聚丙烯缝线牵引悬吊带状肌、气管及甲状腺腺叶的缝线牵引悬吊法。缝线牵引悬吊组51 例,常规腔镜组57 例。比较2组术中及术后指标。结果 2 组均顺利完成手术。缝线牵引悬吊组较常规腔镜组的腺叶切除手术时间短[(35。3±7。3)min vs。(43。4±8。4)min,t =-5。342,P<0。001],中央区淋巴结清扫手术时间短[(20。1±3。5)min vs。(27。7±4。9)min,t =-9。271,P<0。001],术中出血量少[10(5~15)ml vs。15(5~30)ml,Z =-6。250,P<0。001],清扫中央区淋巴结数量多[8(3~13)个vs。6(4~10)个,Z =3。272,P =0。001],术后一过性喉返神经损伤少,但差异无统计学意义(1 例vs。8 例,χ2 = 3。678,P =0。055]。2 组术后住院时间、淋巴漏、标本发现甲状旁腺、甲状旁腺功能减退、疼痛评分及美容效果评分差异无统计学意义(P>0。05)。结论 缝线牵引悬吊法可缩短手术时间,减少术中出血,减少喉返神经损伤的发生,增加中央区淋巴结清扫数目。
Application of Suture Traction Suspension Method in Anterior Chest Approach Endoscopic Thyroid Cancer Radical Surgery
Objective To explore the application value of suture traction suspension method in endoscopic thyroid cancer radical surgery through the anterior chest approach.Methods A retrospective analysis was made on 108 cases of papillary thyroid cancer from January 2020 to December 2022,who underwent unilateral lobectomy and ipsilateral central lymph node dissection through anterior chest approach.After May 2021,the suture traction and suspension method was gradually carried out by using 2-0 polypropylene suture to suspend the muscles,trachea,and thyroid gland lobes.There were 51 cases in the suture traction suspension group and 57 cases in the conventional endoscopic group.The intraoperative and postoperative indicators were compared between the two groups.Results The surgery was successfully completed in both groups.As compared to the conventional endoscopic group,the suture traction suspension group had shorter surgical time for thyroidectomy[(35.3±7.3)min vs.(43.4±8.4)min,t =-5.342,P<0.001],shorter surgical time for central lymph node dissection[(20.1±3.5)min vs.(27.7±4.9)min,t =-9.271,P<0.001],less intraoperative bleeding[10(5-15)ml vs.15(5-30)ml,Z =-6.250,P<0.001],and more central lymph nodes dissected[8(3-13)vs.6(4-10),Z =3.272,P =0.001].There were fewer cases of transient recurrent laryngeal nerve injury after surgery in the suture traction suspension group,but no statistical significance was noted(1 case vs.8 cases,χ2 =3.678,P =0.055).There were no statistically significant differences in postoperative hospitalization time,postoperative lymph leakage,parathyroid gland detection in postoperative specimens,postoperative hypoparathyroidism,postoperative pain score,and postoperative cosmetic effect score between the two groups(P>0.05).Conclusion Suture traction suspension method can shorten surgical time,reduce intraoperative bleeding,reduce the occurrence of recurrent laryngeal nerve injury,and increase the number of central lymph node dissection.

Thyroid tumorEndoscopic surgerySuture traction suspension method

周振华、刘细平、孙科、江细民、徐绍忠、周勇

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中南大学湘雅医学院附属株洲医院甲状腺、胃小肠、疝外科,株洲 412007

甲状腺肿瘤 内镜手术 缝线牵引悬吊法

2024

中国微创外科杂志
北京大学

中国微创外科杂志

CSTPCD北大核心
影响因子:2.21
ISSN:1009-6604
年,卷(期):2024.24(1)
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