探讨改良式中间上入路根治术治疗甲状腺癌的安全性。

纳入2020年1月至2022年12月76例甲状腺癌患者，按数字表法将患者随机分为传统组和改良组，每组各38例。均为腔镜手术，传统组患者应用传统外侧入路，改良组患者采用改良式中间上入路。数据采用SPSS 19.0统计软件分析，并发症等计数资料以[例(%)]表示，采用χ²检验；围手术期指标和血液学指标等计量资料以（）表示，采用独立样本t检验。以P<0.05差异有统计学意义。

改良组患者术中出血量、手术时间及术后引流时间均少于传统组（P<0.05）；术后第3天，改良组患者血清钙、甲状旁腺激素水平降幅小于传统组（t=14.998、2.907，P<0.05）；改良组患者甲状旁腺损伤率及低钙血症发生率（0%、2.6%），显著低于传统组（18.4%、23.7%），（χ²=7.710，7.370，P<0.05）；改良组患者出现喉返神经及喉上神经损伤发生率（0%、5.3%）较传统组（5.3%、13.2%）偏低，但组间比较差异无统计学意义(χ²=2.540、1.416，P>0.05)；术后1年内，改良组患者复发3例，复发率7.9%，传统组患者复发9例，复发率23.7%，两组比较差异有统计学意义（χ²=4.547，P<0.05）。

改良式中间上入路根治术在甲状腺癌的治疗中应用价值较高，可显著缩短手术时间和术后引流时间，减少术中出血量，降低术后并发症及肿瘤复发率。

To investigate the safety of modified intermediate upper approach radical resection in the treatment of thyroid cancer.

A total of 76 patients with thyroid cancer from January 2020 to December 2022 were included and randomly divided into traditional group and improved group according to numerical table method, with 38 patients in each group. All endoscopic operations were performed. The traditional lateral approach was used in the traditional group, and the modified intermediate upper approach was used in the improved group. SPSS 19.0 statistical software was used to analyze the data. The statistical data such as complications were presented as [n (%)] and χ² test was used. Perioperative indicators and hematological indicators were expressed as () and compared by independent sample t test. The difference was statistically significant with P<0.05.

The amount of blood loss, operation time and postoperative drainage time in the improved group were lower than those in the traditional group (P<0.05). On the 3rd day after surgery, serum calcium and parathyroid hormone levels in the improved group were lower than those in the traditional group (t=14.998, 2.907, P<0.05). The incidence of parathyroid injury and hypocalcemia in the improved group (0% and 2.6%) were significantly lower than those in the traditional group (18.4% and 23.7%) (χ²=7.710, 7.370, P<0.05). The incidence of recurrent and superior laryngeal nerve injury in the improved group (0%, 5.3%) was lower than that in the traditional group (5.3%, 13.2%), but there was no significant difference between the two groups (χ²=2.540, 1.416, P>0.05). Within 1 year after surgery, 3 patients in the improved group had recurrence, the recurrence rate was 7.9%, and 9 patients in the traditional group had recurrence, the recurrence rate was 23.7%, the difference between the two groups was statistically significant (χ²=4.547, P<0.05).

In the treatment of thyroid cancer, the modified intermediate upper approach has high application value, which can significantly shorten the operation time and postoperative drainage time, reduce the amount of intraoperative blood loss, and reduce the incidence of postoperative complications and tumor recurrence.