陈亮　宋占春　秦伟

[摘要] 目的 比较改良Miccoli术式与传统术式在甲状腺腺叶切除中的效果。 方法 选取2014年6月～2017年6月辽宁省抚顺市中心医院收治144例甲状腺良性疾病手术患者，依照随机数字表法分成对照组和观察组，每组各72例，观察组采用Miccoli术，对照组采用传统术式。对两组患者对两组患者手术指标、以及术后3 d疼痛VAS评分和反流症状指数量表评分（RSI）、术后3个月声音障碍程度（VHI）评分等进行比较。并对两组患者手术前后血钙、甲状旁腺素（PTH）和并发症发生率进行比较。 结果 观察组患者切口长度、手术时间和术中出血量均显著小于对照组，差异有高度统计学意义（P < 0.01）；观察组术后引流量低于对照组，住院时间短于对照组，颈部活动恢复时间早于对照组，差异有高度统计学意义（P < 0.01）。患者的术后3 d VAS评分显著低于对照组，差异有高度统计学意义（P < 0.01）；RSI评分和术后3个月VHI评分比较，差异无统计学意义（P > 0.05）。术后3 d，觀察组患者血钙和PTH水平显著高于对照组，差异有高度统计学意义（P < 0.01）。观察组患者不良反应发生率显著低于对照组，差异有高度统计学意义（P < 0.01）。 结论 改良Miccoli术应用于甲状腺腺叶切除治疗较传统术式疗效显著，具有创伤小、恢复快、美观等优点，更有助于维持血钙和PTH的稳定，不良反应较少，值得临床推广。

[关键词] 甲状腺腺叶切除；改良Miccoli术式；传统术式；甲状旁腺素

[中图分类号] R736.1 [文献标识码] A [文章编号] 1673-7210（2018）04（b）-0131-04

[Abstract] Objective To compare the effect of modified Miccoli and traditional open surgery in the treatment of thyroid gland lobectomy. Methods From June 2014 to June 2017， in Fushun Central Hospital， 144 patients with benign thyroid diseases were selected， they were divided into control group and observation group， with 72 cases in each group， according to the random number table method， observation group was given modified Miccoli surgery， control group was given traditional surgery. The surgical indexes such as the length of incision， the time of operation， the surgical indexs， VAS and RSI scores postoperative 3 days， VHI score postoperative of 3 months and cosmetic effect in two groups were compared， and the incidence of blood calcium， parathyroid hormone （PTH） before and after operation and the incidence of complications in two groups were compared. Results The postoperative drainage volume in observation group was lower than control group， the hospitalization time was shorter than control group， and the recovery time of cervical movement was earlier than control group， the differences were statistically significant （P < 0.01）； compared with control group， the patients in observation group had less flow rate， shorter hospitalization time and faster recovery time in the neck， the differences were statistically significant （P < 0.01）. After 3 days of operation， the VAS score observation group was significantly lower than control group， the difference was statistically significant （P < 0.01）. But there was no significant difference in RSI score and VHI score between two groups after the operation 3 months. After 3 days of operation， the level of blood calcium and PTH in observation group was significantly higher than control group， the differences were statistically significant （P < 0.01）. The incidence of adverse reactions in observation group was significantly lower than control group， the differences were statistically significant （P < 0.01）. Conclusion Modified Miccoli is better than traditional operation in the treatment of thyroid lobectomy. It has the advantages of less trauma， quicker recovery and better appearance. It helps maintain the stability of blood calcium and PTH， and has fewer side effects. It is worthy of clinical promotion.

[Key words] Thyroid gland lobectomy； Modified Miccoli surgery； Traditional surgery； Parathyroid hormone

甲状腺疾病是临床上发生较多的一类疾病，如结节性甲状腺肿、甲状腺瘤和结节性甲状腺肿囊性变等，临床上以手术切除治疗为主[1]。但是，该病的发生对象主要以女性为主，受心理、生理和社会因素等转变的影响，患者对于手术美容的要求也越来越高[2-3]。改良Miccoli术式切口仅2～3 cm，不仅仅可以完全切除病变，还能够最大限度的缩小和隐藏手术疤痕，安全性较高[4-5]。甲状腺手术过程中容易伤及甲状旁腺[6]，导致血钙水平和甲状旁腺功能降低。因此，本研究探讨改良Miccoli术式与传统术式对甲状腺腺叶切除治疗临床效果和对血钙及甲状旁腺素（PTH）的影响，现报道如下：