甲状腺无张力切除术——77例初次手术结果分析

I. Sleptsov, R. Chernikov, I. Sablin, A. Pushkaruk, N. Timofeeva
{"title":"甲状腺无张力切除术——77例初次手术结果分析","authors":"I. Sleptsov, R. Chernikov, I. Sablin, A. Pushkaruk, N. Timofeeva","doi":"10.14341/serg12718","DOIUrl":null,"url":null,"abstract":"BACKGROUND: Surgeons from all over the world make considerable efforts to reduce thyroid intraoperative complications such as recurrent laryngeal nerves trauma and parathyroid vascular supply damage.AIM: The aim of the study was improving thyroidectomy technique to reduce the rate of postoperative complications.MATERIALS AND METHODS: Inclusion criteria were primary thyroid operation in cases of papillary or medullary cancer, follicular tumours (Bethesda IV) and Grave’s disease. Thyroid volume ranged from 12–70 ml. Tension-free technique of thyroidectomy (TFT) was suggested by the authors of this study. Key points of TFT are the following: the first step is the complete dissection of Berry ligament fibers and terminal branches of lower thyroid arteries and vein. There is only lateral traction while medial traction is not applied at all. Mobilization of the upper parathyroid gland is performed at the medial thyroid surface. Thyroid lobe is extracted out of its bed beginning with the lower pole only after complete dissection of Berry’s ligament, vessels and parathyroid glands. The last step of the operation is the dissection of the upper pole thyroid vessels. The mobilized lobe is easily withdrawn downwards, that leads to space increase between external branch of the superior laryngeal nerve and the upper pole of the lobe. Transient and continuous neuromonitoring as well as optical magnification and headlamps were used during operations. Vocal cords function was controlled before and after surgery (on the first day) by means of ultrasound or endoscopic laryngoscopy. Ionized calcium and parathyroid hormone levels were checked in cases of total thyroidectomy group on the day of surgery, on the 1st and 14th postoperative days.RESULTS: 77 consecutive patients were included into the study (continuous sampling of patients). 33 hemithyroidectomies, 13 hemithyroidectomies with central ipsilateral neck dissection, 21 thyroidectomies, 8 thyroidectomies with central neck dissection, 2 thyroidectomies with central and lateral neck dissection were performed by the same surgeon. All the operations were performed by tension-free technique (TFT). There were no cases of loss of signal from the recurrent laryngeal nerves function during all the operations. One case of postoperative transient hypoparathyroidism finished with normalization of parathyroid hormone and calcium levels in 2 weeks after the operation.CONCLUSION: initial experience in TFT allows to recommend this procedure for further practicing and examination.","PeriodicalId":30783,"journal":{"name":"Endokrinnaia khirurgiia","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2022-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"2","resultStr":"{\"title\":\"Tension-free thyroidectomy — results of the initial 77 operations\",\"authors\":\"I. Sleptsov, R. Chernikov, I. Sablin, A. Pushkaruk, N. Timofeeva\",\"doi\":\"10.14341/serg12718\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"BACKGROUND: Surgeons from all over the world make considerable efforts to reduce thyroid intraoperative complications such as recurrent laryngeal nerves trauma and parathyroid vascular supply damage.AIM: The aim of the study was improving thyroidectomy technique to reduce the rate of postoperative complications.MATERIALS AND METHODS: Inclusion criteria were primary thyroid operation in cases of papillary or medullary cancer, follicular tumours (Bethesda IV) and Grave’s disease. Thyroid volume ranged from 12–70 ml. Tension-free technique of thyroidectomy (TFT) was suggested by the authors of this study. Key points of TFT are the following: the first step is the complete dissection of Berry ligament fibers and terminal branches of lower thyroid arteries and vein. There is only lateral traction while medial traction is not applied at all. Mobilization of the upper parathyroid gland is performed at the medial thyroid surface. Thyroid lobe is extracted out of its bed beginning with the lower pole only after complete dissection of Berry’s ligament, vessels and parathyroid glands. The last step of the operation is the dissection of the upper pole thyroid vessels. The mobilized lobe is easily withdrawn downwards, that leads to space increase between external branch of the superior laryngeal nerve and the upper pole of the lobe. Transient and continuous neuromonitoring as well as optical magnification and headlamps were used during operations. Vocal cords function was controlled before and after surgery (on the first day) by means of ultrasound or endoscopic laryngoscopy. Ionized calcium and parathyroid hormone levels were checked in cases of total thyroidectomy group on the day of surgery, on the 1st and 14th postoperative days.RESULTS: 77 consecutive patients were included into the study (continuous sampling of patients). 33 hemithyroidectomies, 13 hemithyroidectomies with central ipsilateral neck dissection, 21 thyroidectomies, 8 thyroidectomies with central neck dissection, 2 thyroidectomies with central and lateral neck dissection were performed by the same surgeon. All the operations were performed by tension-free technique (TFT). There were no cases of loss of signal from the recurrent laryngeal nerves function during all the operations. One case of postoperative transient hypoparathyroidism finished with normalization of parathyroid hormone and calcium levels in 2 weeks after the operation.CONCLUSION: initial experience in TFT allows to recommend this procedure for further practicing and examination.\",\"PeriodicalId\":30783,\"journal\":{\"name\":\"Endokrinnaia khirurgiia\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-02-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Endokrinnaia khirurgiia\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.14341/serg12718\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Endokrinnaia khirurgiia","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14341/serg12718","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 2

摘要

背景:世界各地的外科医生都在努力减少甲状腺术中并发症,如喉返神经损伤和甲状旁腺血管供应损伤。目的:本研究旨在改进甲状腺切除术的技术,以降低术后并发症的发生率。材料和方法:纳入标准为癌症乳头状或髓质、毛囊肿瘤(Bethesda IV)和Grave病的原发性甲状腺手术。甲状腺体积范围为12–70 ml。本研究的作者提出了甲状腺切除术(TFT)的无张力技术。TFT的要点如下:第一步是完全剥离Berry韧带纤维和甲状腺下动静脉的终末支。只有外侧牵引,而内侧牵引则根本不起作用。上甲状旁腺的活动是在甲状腺内侧表面进行的。只有在完全剥离Berry韧带、血管和甲状旁腺后,才能从下极开始将甲状腺叶从床上取出。手术的最后一步是解剖甲状腺上极血管。活动的肺叶很容易向下抽出,这导致喉上神经外支和肺叶上极之间的空间增加。手术期间使用了瞬态和连续神经监测以及光学放大和前照灯。术前和术后(第一天)通过超声或内窥镜喉镜控制声带功能。在甲状腺全切除术组的病例中,在手术当天、术后第1天和第14天检查电离钙和甲状旁腺激素水平。结果:77名连续患者被纳入研究(对患者进行连续抽样)。由同一外科医生进行了33例甲状腺半切除术、13例甲状腺同侧中央颈淋巴结清扫术、21例甲状腺切除术、8例甲状腺中央颈淋巴结结清扫术和2例甲状腺中央和侧颈淋巴结清扫术。所有手术均采用无张力技术(TFT)进行。所有手术中均未出现喉返神经功能信号丢失的病例。1例术后短暂性甲状旁腺功能减退,术后2周甲状旁腺激素和钙水平恢复正常。结论:TFT的初步经验可以推荐该程序进行进一步的实践和检查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Tension-free thyroidectomy — results of the initial 77 operations
BACKGROUND: Surgeons from all over the world make considerable efforts to reduce thyroid intraoperative complications such as recurrent laryngeal nerves trauma and parathyroid vascular supply damage.AIM: The aim of the study was improving thyroidectomy technique to reduce the rate of postoperative complications.MATERIALS AND METHODS: Inclusion criteria were primary thyroid operation in cases of papillary or medullary cancer, follicular tumours (Bethesda IV) and Grave’s disease. Thyroid volume ranged from 12–70 ml. Tension-free technique of thyroidectomy (TFT) was suggested by the authors of this study. Key points of TFT are the following: the first step is the complete dissection of Berry ligament fibers and terminal branches of lower thyroid arteries and vein. There is only lateral traction while medial traction is not applied at all. Mobilization of the upper parathyroid gland is performed at the medial thyroid surface. Thyroid lobe is extracted out of its bed beginning with the lower pole only after complete dissection of Berry’s ligament, vessels and parathyroid glands. The last step of the operation is the dissection of the upper pole thyroid vessels. The mobilized lobe is easily withdrawn downwards, that leads to space increase between external branch of the superior laryngeal nerve and the upper pole of the lobe. Transient and continuous neuromonitoring as well as optical magnification and headlamps were used during operations. Vocal cords function was controlled before and after surgery (on the first day) by means of ultrasound or endoscopic laryngoscopy. Ionized calcium and parathyroid hormone levels were checked in cases of total thyroidectomy group on the day of surgery, on the 1st and 14th postoperative days.RESULTS: 77 consecutive patients were included into the study (continuous sampling of patients). 33 hemithyroidectomies, 13 hemithyroidectomies with central ipsilateral neck dissection, 21 thyroidectomies, 8 thyroidectomies with central neck dissection, 2 thyroidectomies with central and lateral neck dissection were performed by the same surgeon. All the operations were performed by tension-free technique (TFT). There were no cases of loss of signal from the recurrent laryngeal nerves function during all the operations. One case of postoperative transient hypoparathyroidism finished with normalization of parathyroid hormone and calcium levels in 2 weeks after the operation.CONCLUSION: initial experience in TFT allows to recommend this procedure for further practicing and examination.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
4
审稿时长
6 weeks
期刊最新文献
Insulinoma: analysis of prevalence and incidence in the world In memory of Bondarenko Vladimir Olegovich (07.06.1960–15.08.2022) To the 120th anniversary of the birth of Professor Oleg Vladimirovich Nikolaev (1903–1980) Thyroid functional autonomy — sclerotherapy and radioactive iodine therapy: case report Non-recurrent laryngeal nerve in thyroid and parathyroid surgery
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1