李力波 任浩棠 陈建新

[摘要] 目的 探讨甲状腺被膜内次全切除术近期并发症的发生情况。 方法 选取2012年9月～2014年9月在广东东莞市人民医院接受治疗的甲状腺疾病患者84例。将其随机分为两组，观察组42例患者采用甲状腺被膜内次全切除术，对照组42例患者实施被膜外次全切除术。记录并比较两组患者手术时间、术中出血量、镇痛剂使用量及住院时间；比较两组患者术后7 d内甲状旁腺功能减退、低钙血症及低钙症状发生率。术后随访4周，观察比较两组患者饮水呛咳、声音嘶哑、手足抽搐或麻木、喉返神经损伤、呼吸困难或窒息感等并发症发生情况。 结果 两组患者手术时间、术中出血量、住院时间比较差异均无统计学意义（P > 0.05）。术后7 d，观察组甲状旁腺功能减退（2.38%）、低钙血症（4.76%）、抽搐和惊厥低钙症状发生率（0.00%、0.00%）显著低于对照组（30.95%、40.47%、16.67%、7.14%），差异均有统计学意义（P < 0.05）。观察组饮水呛咳、声音嘶哑及手足抽搐或麻木发生率稍低于对照组，但差异无统计学意义（P > 0.05），两组并发症总发生率比较，差异有统计学意义（P < 0.05）。观察组患者中，27例接受单侧切除术，1例（3.70%）患者发生并发症；15例接受双侧切除术，4例（26.67%）患者发生并发症。对照组患者中，26例接受单侧切除术，5例（19.23%）患者发生并发症；16例患者接受双侧切除术，10例（62.50%）患者发生并发症。行单侧切除术的患者术后并发症的发生率低于行双侧切除的患者，差异有高度统计学意义（P < 0.01）。 结论 甲状腺被膜内次全切除术近期并发症发生情况较少，且单侧切除术术后的情况要优于双侧切除术术后的情况。

[关键词] 甲状腺疾病；甲状腺被膜内次全切除术；被膜外次全切除术次全切除术；近期并发症

[中图分类号] R581 [文献标识码] A [文章编号] 1673-7210（2015）06（a）-0115-05

Clinical analysis of short-term complications of membrane subtotal thyroid resection

LI Libo REN Haotang CHEN Jianxin

The First Area of General Surgery， the People's Hospital of Dongguan City， Guangdong Province， Dongguan 523059， China

[Abstract] Objective To investigate the short-term complications of membrane subtotal thyroid resection. Methods 84 patients with thyroid diseases from September 2012 to September 2014 in the People's Hospital of Dongguan City were selected， and they were randomly divided into two groups， 42 patients of the observation group were given thyroid envelope subtotals excision； 42 patients of the control group were given the implementation of the outer envelope subtotals resection. Operation time， amount of bleeding during the operation， analgesic usage and hospitalization time of two groups were recorded and compared. The incidences of parathyroid function decline， hypocalcemia calcium symptoms， low calcium 7 days after operation were compared between the two groups. Patients were followed up for 4 weeks after operation， and the incidences of drinking cough， hoarseness， tetany or numbness， recurrent laryngeal nerve injury， difficulty breathing or a sense of suffocation of patients in two groups were observed and compared. Results The operation time， intraoperative blood loss and hospital stay of two groups had no statistical significance （P > 0.05）. After 7 days with operation， the incidences of parathyroid function decline （2.38%）， hypocalcaemia （4.76%） and tic and convulsions（0.00%， 0.00%） of observation group were significantly lower than the control group （30.95%， 40.47%， 16.67%， 7.14%）， the differences were statistically significant （P < 0.05）. The incidence of drinking cough， hoarseness， tetany or numbness in the observation group were lower than those of the control group， but the differences had no statistically significant （P > 0.05）， the total incidence of complications in the two groups had statistically significant difference （P < 0.05）. Patients in the observation group， 27 patients received unilateral resection， just 1 case had complication； 15 cases received bilateral resection， 4 cases （26.67%） had complications. In the control group， 26 cases received unilateral resection， 5 cases （19.23%） had complications； 16 cases received bilateral resection of the patients， 10 cases （62.50%） had complications. The incidence of the complications of those who accepted the unilateral resection was lower than those who accepted the bilateral resection， the difference was statistically significant （P < 0.01）. Conclusion In the treatment of thyroid diseases， the rate of membrane subtotal thyroid resection is lower than the outside capsule subtotal thyroid resection. In addition， unilateral resection is superior to that of bilateral resection.

[Key words] Thyroid disease； Membrane subtotal thyroid resection； Outside capsule subtotal thyroid resection； Short-term complications

甲状腺疾病是临床上的常见病和多发病，据统计[1]，其在人群中的发生率为3%～5%，虽然随着医疗卫生水平的不断提高及医学知识的普及，使得各类甲状腺疾病的预防措施日臻完善，其发病率呈现下降趋势，但是其发病率仍较高。目前，临床上比较常见的甲状腺疾病如结节性甲状腺肿、甲状腺腺瘤、桥本氏病、甲亢等，无论严重程度如何，大多数采用手术切除术进行治疗[2-3]。但是……