研究肌间隙及咽后间隙入路法中央区切除术在甲状腺癌再次手术中的应用效果。

回顾性分析2017年7月至2019年6月81例行甲状腺癌再次手术的患者资料。根据手术方案将患者分为两组。传统组患者43例采用传统甲状腺中央区切除术，改良组患者38例采用肌间隙及咽后间隙入路法中央区切除术。使用统计学软件SPSS 24.0分析，围术期指标等计量资料采用(±s)表示，独立样本t检验；术后并发症等计数资料采用χ²检验。以P<0.05为检验标准。

两组在围术期指标比较中，手术时间、术中出血量、术后住院时间及术后第1天甲状旁激素恢复水平差异均无统计学意义(P>0.05)。术后声音嘶哑、饮水呛咳、吞咽困难、低钙血症的并发症比较中，两组差异均无统计学意义(P>0.05)。术后随访4～22个月，平均随访11.6个月，两组患者随访期间，均无死亡以及复发病例。所有患者的甲状旁腺素在术后1～3个月均逐渐恢复正常，无永久性甲状旁腺功能低下及永久性喉返神经损伤发生。

在甲状腺再次手术中，以肌间隙及咽后间隙入路，在甲状腺背侧区域进行手术，安全可行，且效果满意，值得在临床推荐使用。

To evaluate the clinical outcome of intermuscular and interthroat approaches in the reoperation of thyroid cancer.

From July 2017 to June 2019, a retrospective analysis were performed in 81 patients who underwent reoperation for thyroid cancer. According to the operation procedures, 43 patients who treated with traditional central thyroidectomy were divided into the traditional group, while38 patients who treated with central thyroidectomy with intermuscular and interthroat approaches were divided into the improved group. Statistical software SPSS24.0 were used for data analysis. Measurement data such as Perioperative indexes were represented as (±s), and were examined by independent t test. Chi-square test were performed for count data analysis such as complication rate. P<0.05 was considered as statistically significant difference.

There were no significant difference between the Improved group and the traditional group in terms of the perioperative indexes, such as the operation time, the amount of bleeding during the operation, the postoperative hospital stay and the recovery level of parathyroid hormone on the first day after the operation (P>0.05). There was no statistically significant difference between the Improved group and the traditional group in terms of postoperative complications such as hoarseness, water choking, dysphagia and hypocalcemia (P>0.05). Postoperative followed-up of 4-22 months were performed (with average of 11.6 months ). During the follow-up period, there was no death or recurrence in both groups. The parathyroid hormone of all patients gradually returned to normal 1-3 months after operation, and there was no permanent hypoparathyroidism or permanent recurrent laryngeal nerve injury.

In the reoperation of thyroid cancer, it is safe and feasible to operate in the dorsal area of thyroid gland through intermuscular and interthroat approaches, and the clinical outcome is satisfactory, which is worth recommending in clinical practice.