CAJ | 학술논문

目的比较单独原切口入路与原切口入路和侧入路结合行甲状腺再手术的疗效.方法将2010年6月至2012年6月中山大学孙逸仙纪念医院甲状腺外科入院的甲状腺再手术462例按双单住院号分2组,单号248例为A组,行原切口入路甲状腺手术,双号214例为B组,行原切口入路和侧入路结合甲状腺手术.比较2组术中、术后出血量、术后止血再次手术率、术后暂时性、迟发性及永久性喉返神经损伤性声音嘶哑、术后暂时性及永久性甲状旁腺功能低下、伤口感染和肿胀发生率及消退时间.结果 A组vs B组术中伤口出血量为(43±0.8)ml vs(25±0.3)ml,P=0.021,差异有统计学意义；A组vs B组术后伤口出血量为(37±1.4)ml vs(21±1.2)ml,P=0.013,差异有统计学意义；A组vs B组术后止血再次手术率,1.61％ vs 0.93％,P=0.034,差异有统计学意义；A组vs B组术后暂时性声嘶4.44％ vs 2.33％,P =0.023,差异有统计学意义；A组vs B组迟发性喉返神经损伤性声音嘶哑3.63％vs 1.87％,P=0.042,差异有统计学意义；A组vs B组术后暂时性甲状旁腺功能低下5.24％ vs 2.80％,P=0.037,差异有统计学意义；A组vs B组术后伤口肿胀发生率77.8％ vs 54.8％,P=0.046,差异有统计学意义；A组vs B组伤口肿胀的消退时间16.2 d vs 10.7 d,P=0.038,P＜0.05,差异有统计学意义；2组术后伤口感染发生率差异没有统计学意义(1.21％ vs 1.40％,P=0.69 ＞0.05),2组术后均未发生永久性喉返神经损伤性声音嘶哑(0 vs0,0 vs0,P＞0.05)及永久性甲状旁腺功能低下(0 vs0,0 vs0,P＞0.05).结论原切口入路和侧入路结合可有效降低甲状腺再手术并发症的发生率.
목적 비교단독원절구입로여원절구입로화측입로결합행갑상선재수술적료효.방법 장2010년6월지2012년6월중산대학손일선기념의원갑상선외과입원적갑상선재수술462례안쌍단주원호분2조,단호248례위A조,행원절구입로갑상선수술,쌍호214례위B조,행원절구입로화측입로결합갑상선수술.비교2조술중、술후출혈량、술후지혈재차수술솔、술후잠시성、지발성급영구성후반신경손상성성음시아、술후잠시성급영구성갑상방선공능저하、상구감염화종창발생솔급소퇴시간.결과 A조vs B조술중상구출혈량위(43±0.8)ml vs(25±0.3)ml,P=0.021,차이유통계학의의；A조vs B조술후상구출혈량위(37±1.4)ml vs(21±1.2)ml,P=0.013,차이유통계학의의；A조vs B조술후지혈재차수술솔,1.61％ vs 0.93％,P=0.034,차이유통계학의의；A조vs B조술후잠시성성시4.44％ vs 2.33％,P =0.023,차이유통계학의의；A조vs B조지발성후반신경손상성성음시아3.63％vs 1.87％,P=0.042,차이유통계학의의；A조vs B조술후잠시성갑상방선공능저하5.24％ vs 2.80％,P=0.037,차이유통계학의의；A조vs B조술후상구종창발생솔77.8％ vs 54.8％,P=0.046,차이유통계학의의；A조vs B조상구종창적소퇴시간16.2 d vs 10.7 d,P=0.038,P＜0.05,차이유통계학의의；2조술후상구감염발생솔차이몰유통계학의의(1.21％ vs 1.40％,P=0.69 ＞0.05),2조술후균미발생영구성후반신경손상성성음시아(0 vs0,0 vs0,P＞0.05)급영구성갑상방선공능저하(0 vs0,0 vs0,P＞0.05).결론 원절구입로화측입로결합가유효강저갑상선재수술병발증적발생솔.
Objective To compare the curative effects of secondary thyroidectomy between original incision approach combined with side approach and original incision approach alone.Methods According to the hospital number(singular or even) of the 462 patients undergoing secondary thyroidectomy in Sun Yat-sen Memorial Hospital from Jun.2010 to Jun.2012,they were divided into 2 groups:original incision approach groups (group A,248 patients with singular hospital number) and original incision approach combined with side approach groups(group B,214 patients with even hospital number).The 2 groups were compared in postoperative blood loss,re-operation for bleeding,infection,transient or permanent hypoparathyrodism and transient or permanent recurrent laryngeal nerve palsy.Results Intraoperative blood loss of group A and group B was (43 ± 0.8)ml vs (25 ± 0.3) ml,P =0.021.Postoperative blood loss of group A and group B was (37 ± 1.4) ml vs (21 ± 1.2)ml,P =0.013.Re-operation rate for bleeding of group A vs group B was 1.61％ vs 0.93％,P =0.034.Transient recurrent laryngeal nerve palsy of group A vs group B was 4.44％ vs 2.33％,P =0.023.Delayed recurrent laryngeal nerve palsy of group A vs group B was 3.63％ vs 1.87％,P =0.042.The difference had statistical significance.Transient hypoparathyroism rate of group A vs group B was 5.24％ vs 2.80％,P =0.037.Postoperational wound swelling of group A vs group B was 77.8％ vs 54.8％,P =0.046.The difference had statistical significance.Wound swelling recover time of group A vs group B was 16.2 d vs 10.7 d,P =0.038.The difference had statistical significance.The difference had no statistical significance in complications of permanent hypocalcaemia (0 vs 0,P ＞ 0.05),permanent recurrent laryngeal nerve palsy (0 vs 0,P ＞ 0.05) and rate of infection between the 2 groups (1.21％ vs 1.40％,P＞0.05).Conclusion Original incision approach combined with side approach is much more safe and can effectively reduce the complication rate of secondary thyroidectomy.