• 南京鼓樓醫(yī)院集團(tuán)宿遷市人民醫(yī)院普外科(江蘇宿遷 223800);

目的  探討胸骨端離斷頸前肌群翻轉(zhuǎn)固定在雙側(cè)巨大甲狀腺腫物切除術(shù)中的應(yīng)用優(yōu)勢。
方法  采用胸骨端離斷頸前肌群翻轉(zhuǎn)固定法完成甲狀腺手術(shù)53例(觀察組),采用頸白線切口行甲狀腺手術(shù)44例(對照組),手術(shù)均由同一組醫(yī)師完成。分別對2組患者的手術(shù)時(shí)間、手術(shù)野顯露效果、術(shù)中出血量、術(shù)后并發(fā)癥及術(shù)后引流量進(jìn)行比較。
結(jié)果  2組患者在性別、年齡、疾病構(gòu)成以及腫瘤大小方面的差異均無統(tǒng)計(jì)學(xué)意義(P>0.05)。觀察組的手術(shù)時(shí)間、術(shù)中出血量及術(shù)后引流量短(少)于對照組(P<0.01),術(shù)后并發(fā)癥發(fā)生率低于對照組(P=0.04);手術(shù)野暴露效果優(yōu)于對照組(P<0.01)。
結(jié)論  經(jīng)胸骨端入路行雙側(cè)巨大甲狀腺手術(shù)是可行的,手術(shù)操作簡便,手術(shù)野顯露優(yōu)于頸白線切口,術(shù)后并發(fā)癥少,值得臨床推廣。

引用本文: 朱信強(qiáng),張明,丁闖,陳焰,管小青. 頸前肌群胸骨端離斷入路在雙側(cè)巨大甲狀腺腫物切除術(shù)中的應(yīng)用. 中國普外基礎(chǔ)與臨床雜志, 2013, 20(1): 77-81. doi: 復(fù)制

1. Jaroszuk A, Kamiński G. Arterial thyroid embolization in thyroid diseases[J]. Pol Merkur Lekarski,2011, 31(185):284-287.
2. Zullino A, Maiuolo A, Fumarola A, et al. Minimally invasive thyroidectomy and the differentiated lesions:the way to follow[J]. Eur Rev Med Pharmacol Sci,2012, 16(4):519-524.
3. 李曉, 戈佳云, 崔江云. 甲狀腺疾病外科治療的熱點(diǎn)和難點(diǎn)[J]. 中國普外基礎(chǔ)與臨床雜志, 2008, 15(5):307-309.
4. 劉星偉, 呂寶軍, 殷放, 等. 不同手術(shù)入路在甲狀腺手術(shù)中的應(yīng)用[J]. 中國實(shí)用醫(yī)藥, 2010, 5(22): 26-27.
5. 劉春萍, 黃韜. 甲狀腺手術(shù)喉返神經(jīng)損傷的原因及處理探討[J]. 中國普外基礎(chǔ)與臨床雜志, 2008, 15(5):314-317.
6. 李新營, 呂新生, 王志明, 等. 外科手術(shù)治療甲狀腺手術(shù)所致喉返神經(jīng)損傷[J]. 中國普通外科雜志, 2007, 16(11):1038-1041.
7. 于克明. 甲狀腺手術(shù)入路的體會(huì)[J]. 中國保健醫(yī)學(xué)研究版, 2007, 15(8): 68.
8. Godballe C, Madsen AR, Pedersen HB, et al. Post-thyroidectomyhemorrhage:a national study of patients treated at the Danish departments of ENT Head and Neck Surgery[J]. Eur Arch Otor-hinolaryngol, 2009, 266(12): 1945-1952.
9. 王會(huì)元, 蔡偉, 李非, 等. 甲狀腺手術(shù)切口大小對術(shù)后瘢痕美觀的影響[J]. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(9): 975-979.
10. 龔日祥, 張敏, 羅書畫, 等. 甲狀腺手術(shù)中常規(guī)顯露喉返神經(jīng)的安全性分析[J]. 四川大學(xué)學(xué)報(bào)(醫(yī)學(xué)版), 2008, 39(3): 464-466 .
11. Morton RP, Mak V, Moss D, et al. Risk of bleeding after thyroidsurgery:matched pairs analysis[J]. J Laryngol Otol, 2012, 126(3): 285-288.
12. Calò PG, Pisano G, Piga G, et al. Postoperative hematomas after thyroid surgery. Incidence and risk factors in our experience[J]. Ann Ital Chir, 2010,81(5): 343-347.
13. Lombardi CP, Raffaelli M, De Crea C, et al. Complications in thyroid surgery[J]. Minerva Chir, 2007, 62(5):395-408.
14. Safioleas M, Stamatakos M, Rompoti N, et al. Complications of thyroid surgery[J]. Chirurgia (Bucur), 2006,101(6): 571-581.
15. Agarwal A, Agarwal S, Tewari P, et al. Clinicopathological profile, airway management, and outcome in huge multinodulargoiters:an institutional experience from an endemic goiter region[J]. World J Surg, 2012, 36(4): 755-760.
16. Agarwal A, Mishra AK, Gupta SK, et al. High incidence of tracheomalacia in longstanding goiters: experience from an endemic goiter region[J]. World J Surg, 2007 , 31(4):832-837.
17. 安常明, 唐平章, 徐震綱, 等. 甲狀旁腺素檢測對甲狀腺全切除后低鈣癥狀的診斷價(jià)值[J]. 中華耳鼻咽喉頭頸外科雜志, 2010, 45(3): 217-221.
18. Del Río L, Castro A, Bernáldez R, et al. Parathyroid hormone as a predictor of post-thyroidectomy hypocalcemia[J]. Acta Otorrinolaringol Esp, 2011, 62(4): 265-273.
19. 黃久佐, 汪劭婷, 李小毅. 甲狀腺術(shù)后永久性甲狀旁腺功能低減的防治[J]. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(8): 890-893.
20. Chang LY, O’Neill C, Suliburk J, et al. Sutureless total thyroidectomy:a safe and cost-effective alternative[J]. ANZ J Surg,2011, 81(7-8):510-514 .
21. Kowalski BW, Bierca J, Zmora J, et al. Usefulness of electro-surgical techniques in thyroid gland surgery[J]. Pol Przegl Chir,2012,84(5):225-229.
22. Prichard RS, Murphy R, Lowry A, et al. The routine use of post-operative drains in thyroid surgery: an outdated concept[J]. Ir MedJ, 2010, 103(1):26-27.
23. Samraj K, Gurusamy KS. Wound drains following thyroid surgery[J]. Cochrane Database Syst Rev, 2007 , (4): CD006099.
24. Colak T, Akca T, Turkmenoglu O, et al. Drainage after total thyroidectomy or lobectomy for benign thyroidal disorders[J]. J Zhejiang Univ Sci B, 2008 , 9(4):319-323.
25. Abboud B, Sleilaty G, Rizk H, et al. Safety of thyroidectomy and cervical neck dissection without drains[J]. Can J Surg, 2012 , 55(3):199-203.
  1. 1. Jaroszuk A, Kamiński G. Arterial thyroid embolization in thyroid diseases[J]. Pol Merkur Lekarski,2011, 31(185):284-287.
  2. 2. Zullino A, Maiuolo A, Fumarola A, et al. Minimally invasive thyroidectomy and the differentiated lesions:the way to follow[J]. Eur Rev Med Pharmacol Sci,2012, 16(4):519-524.
  3. 3. 李曉, 戈佳云, 崔江云. 甲狀腺疾病外科治療的熱點(diǎn)和難點(diǎn)[J]. 中國普外基礎(chǔ)與臨床雜志, 2008, 15(5):307-309.
  4. 4. 劉星偉, 呂寶軍, 殷放, 等. 不同手術(shù)入路在甲狀腺手術(shù)中的應(yīng)用[J]. 中國實(shí)用醫(yī)藥, 2010, 5(22): 26-27.
  5. 5. 劉春萍, 黃韜. 甲狀腺手術(shù)喉返神經(jīng)損傷的原因及處理探討[J]. 中國普外基礎(chǔ)與臨床雜志, 2008, 15(5):314-317.
  6. 6. 李新營, 呂新生, 王志明, 等. 外科手術(shù)治療甲狀腺手術(shù)所致喉返神經(jīng)損傷[J]. 中國普通外科雜志, 2007, 16(11):1038-1041.
  7. 7. 于克明. 甲狀腺手術(shù)入路的體會(huì)[J]. 中國保健醫(yī)學(xué)研究版, 2007, 15(8): 68.
  8. 8. Godballe C, Madsen AR, Pedersen HB, et al. Post-thyroidectomyhemorrhage:a national study of patients treated at the Danish departments of ENT Head and Neck Surgery[J]. Eur Arch Otor-hinolaryngol, 2009, 266(12): 1945-1952.
  9. 9. 王會(huì)元, 蔡偉, 李非, 等. 甲狀腺手術(shù)切口大小對術(shù)后瘢痕美觀的影響[J]. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(9): 975-979.
  10. 10. 龔日祥, 張敏, 羅書畫, 等. 甲狀腺手術(shù)中常規(guī)顯露喉返神經(jīng)的安全性分析[J]. 四川大學(xué)學(xué)報(bào)(醫(yī)學(xué)版), 2008, 39(3): 464-466 .
  11. 11. Morton RP, Mak V, Moss D, et al. Risk of bleeding after thyroidsurgery:matched pairs analysis[J]. J Laryngol Otol, 2012, 126(3): 285-288.
  12. 12. Calò PG, Pisano G, Piga G, et al. Postoperative hematomas after thyroid surgery. Incidence and risk factors in our experience[J]. Ann Ital Chir, 2010,81(5): 343-347.
  13. 13. Lombardi CP, Raffaelli M, De Crea C, et al. Complications in thyroid surgery[J]. Minerva Chir, 2007, 62(5):395-408.
  14. 14. Safioleas M, Stamatakos M, Rompoti N, et al. Complications of thyroid surgery[J]. Chirurgia (Bucur), 2006,101(6): 571-581.
  15. 15. Agarwal A, Agarwal S, Tewari P, et al. Clinicopathological profile, airway management, and outcome in huge multinodulargoiters:an institutional experience from an endemic goiter region[J]. World J Surg, 2012, 36(4): 755-760.
  16. 16. Agarwal A, Mishra AK, Gupta SK, et al. High incidence of tracheomalacia in longstanding goiters: experience from an endemic goiter region[J]. World J Surg, 2007 , 31(4):832-837.
  17. 17. 安常明, 唐平章, 徐震綱, 等. 甲狀旁腺素檢測對甲狀腺全切除后低鈣癥狀的診斷價(jià)值[J]. 中華耳鼻咽喉頭頸外科雜志, 2010, 45(3): 217-221.
  18. 18. Del Río L, Castro A, Bernáldez R, et al. Parathyroid hormone as a predictor of post-thyroidectomy hypocalcemia[J]. Acta Otorrinolaringol Esp, 2011, 62(4): 265-273.
  19. 19. 黃久佐, 汪劭婷, 李小毅. 甲狀腺術(shù)后永久性甲狀旁腺功能低減的防治[J]. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(8): 890-893.
  20. 20. Chang LY, O’Neill C, Suliburk J, et al. Sutureless total thyroidectomy:a safe and cost-effective alternative[J]. ANZ J Surg,2011, 81(7-8):510-514 .
  21. 21. Kowalski BW, Bierca J, Zmora J, et al. Usefulness of electro-surgical techniques in thyroid gland surgery[J]. Pol Przegl Chir,2012,84(5):225-229.
  22. 22. Prichard RS, Murphy R, Lowry A, et al. The routine use of post-operative drains in thyroid surgery: an outdated concept[J]. Ir MedJ, 2010, 103(1):26-27.
  23. 23. Samraj K, Gurusamy KS. Wound drains following thyroid surgery[J]. Cochrane Database Syst Rev, 2007 , (4): CD006099.
  24. 24. Colak T, Akca T, Turkmenoglu O, et al. Drainage after total thyroidectomy or lobectomy for benign thyroidal disorders[J]. J Zhejiang Univ Sci B, 2008 , 9(4):319-323.
  25. 25. Abboud B, Sleilaty G, Rizk H, et al. Safety of thyroidectomy and cervical neck dissection without drains[J]. Can J Surg, 2012 , 55(3):199-203.