2019 年第 2 期 第 14 卷

颈白线切开联合带状肌分离入路在甲状腺切除手术中的应用

Application of medial approach combined with cervical strap muscles approach in thyroidectomy

作者：赵轶国李伟邢兆东颜艺超杨晓东王文跃

英文作者：

单位：102206北京大学国际医院胃肠外科

英文单位：

关键词：甲状腺切除术；喉上神经；甲状旁腺；带状肌间入路

英文关键词：

• 摘要：

• 【摘要】目的    探讨颈白线切开联合带状肌分离入路在甲状腺切除手术中的应用。方法    回顾性选取2017年3月至2018年3月北京大学国际医院胃肠外科实施单侧甲状腺切除的患者162例，依手术入路将所有患者分为3组，其中颈白线切开联合带状肌分离入路者为观察组，共40例；颈白线切开合并胸骨甲状肌离断者为对照组A，共32例；单纯颈白线切开者为对照组B，共90例。比较3组术后颈前疼痛程度、术中喉上神经外支显露情况、术后简化嗓音障碍指数量表(VHI-10)评分和术中甲状旁腺误切率。结果    对照组A术后颈前明显疼痛发生率明显高于对照组B和观察组［53.1%(17/32)比18.9%(17/90)、17.5%(7/40)］（均P＜0.05）。对照组A喉上神经外支显露率明显低于对照组B和观察组［62.5%（20/32）比83.3%(75/90)、82.5%（33/40）］（均P＜0.05）。3组术后VHI-10评分和术中甲状旁腺误切率比较，差异均无统计学意义（均P＞0.05）。结论    颈白线切开联合带状肌分离入路较传统方法在显露甲状腺上极方面具有优势，便于喉上神经外支的显露，并可降低术后颈前区疼痛不适的发生率。

• 【Abstract】Objective    To explore the feasibility and advantage of a modified approach which combines medial approach and cervical strap muscle approach in thyroidectomy. Methods    Clinical data of 162 patients who underwent unilateral thyroidectomy in Peking University International Hospital from March 2017 to March 2018 were retrospectively analyzed. The patients were divided into 3 groups according to different operative approaches; 40 patients with the modified approach were in observation group; 32 patients who had traditional medial approach with sternothyroid muscle transection were in control group A; 90 patients who had traditional medial approach with intact sternothyroid muscle were in control group B. Pain intensity, intraoperative identification of external branch of superior laryngeal nerve(EBSLN), postoperative modified voice handicap index(VHI-10) score and resection rate of parathyroid glands were analyzed. Results    Incidence of intolerable pain at anterior cervical region in the control group A was higher than that in the control group B and observation group［53.1%(17/32) vs 18.9%(17/90), 17.5%(7/40)］（P＜0.05）. Identification rate of EBSLN in the control group A was lower than that in the control group B and observation group［62.5%（20/32） vs 83.3%(75/90), 82.5%（33/40）］（P＜0.05）. There were no differences of postoperative VHI-10 score and resection rate of parathyroid glands among the 3 groups（P＞0.05）. Conclusion    Modified approach which combines medial approach and cervical strap muscle approach in thyroidectomy facilitates the identification of EBSLN during operation and reduces the incidence of postoperative neck pain and discomfort.