中国实用外科杂志

中国实用外科杂志

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经胸锁乳突肌肌间入路行甲状腺手术对颈前区功能保护研究

朱    峰，邬一军，沈亦斌，方    云，潘    俊，陈凌慧，朱丽娴，何琦文   

  1. 浙江大学医学院附属第一医院甲状腺疾病诊治中心，浙江杭州 310003
  • 发布日期:2020-07-23

  • Published:2020-07-23

摘要： 目的    探讨经胸锁乳突肌肌间入路（SMIA）行甲状腺切除的可行性及其在颈前区功能的保护作用。方法    回顾性分析2019年5—8月浙江大学医学院附属第一医院甲状腺疾病诊治中心收治的采取SMIA手术治疗的60例单侧甲状腺癌病人的临床资料（SMIA组），以同期采取低领弧形切口颈白线入路（LACA）手术治疗的60例单侧甲状腺癌病人作为对照（LACA组）。比较两组间临床病理特征、手术相关结果及术后颈前区功能的差异。采用EQ-5D-5L量表评估颈前区功能的主观感受，采用Hollander伤口评估量表评定切口愈合的临床效果。结果    两组病人在年龄、性别、肿瘤大小、手术时间、术中出血、淋巴结清扫数目、术后甲状旁腺激素水平、引流量等方面差异均无统计学意义（P>0.05）。术后随访1个月，两组在保护颈前区功能和减少术后颈部不适感觉方面差异有统计学意义（P<0.001），且SMIA组均优于LACA组；在切口愈合及临床效果方面，SMIA组Hollander伤口评估量表得分优于LACA组，差异有统计学意义（P<0.05）。结论    经SMIA行甲状腺切除不增加并发症的发生风险，且对甲状腺手术颈前区功能保护的作用优势明显，是安全可行的手术入路。

关键词: 胸锁乳突肌肌间入路, 甲状腺手术, 颈前区功能保护

Abstract: Functional protection of anterior cervical region by thyroid surgery with sternocleidomastoid intermuscular approach        ZHU Feng，WU Yi-jun，SHEN Yi-bin，et al. Thyroid Center，the First Affiliated Hospital，College of Medicine, Zhejiang University，Hangzhou 310003，China
Corresponding author：WU Yi-jun，E-mail：wuwu5925@zju.edu.cn
Abstract    Objective    To investigate the feasibility of thyroidectomy through the sternocleidomastoid intermuscular approach and its advantages in anterior cervical function protection. Methods    The clinical data of 60 patients underwent thyroidectomy with unilateral thyroid carcinoma by sternocleidomastoid intermuscular approach (SMIA group) in the First Affiliated Hospital，College of Medicine, Zhejiang University from May to August 2019 were analyzed retrospectively. Sixty cases of linea alba cervicalis approach were as a control group (LACA group). The clinicopathological features，surgical outcomes and the differences between the two groups in postoperative anterior cervical function protection were compared. The subjective perception of anterior cervical function was assessed using the EQ-5D-5L scale，and the clinical effect of wound healing was assessed using the Hollander Wound Assessment Scale. Results    There was no significant difference in age，sex，tumor size，operation time，intraoperative bleeding，number of lymph node dissection，postoperative parathyroid hormone and drainage volume between the two groups (P>0.05). The SMIA group was better than the LACA group in protecting anterior cervical function and reducing postoperative neck discomfort，and the difference between the two groups was statistically significant after 1 month of follow-up (P<0.001)；In terms of scores，the Hollander Wound Assessment Scale score of the SMIA group was better than that of the LACA group，and the difference was statistically significant. Conclusion    Thyroidectomy through the sternocleidomastoid intermuscular approach does not increase the risk of complications，and has obvious advantages in the functional protection of the anterior cervical region. It is a safe and feasible surgical approach.

Key words: sternocleidomastoid intermuscular approach, thyroidectomy, anterior cervical function protection