关键词: 分化型甲状腺癌, 精细化甲状腺被膜解剖技术, 环甲隙显露喉返神经方法, 创伤应激指标

Abstract:

Objective To explore the therapeutic effect of meticulous capsule dissection technique （MCDT） combined with recurrent laryngeal nerve （RLN） protection in patients with differentiated thyroid cancer （DTC）. Methods The research subjects were selected from patients with DTC who were admitted to the First Affiliated Hospital of Soochow University. The inclusion period for the cases was from December 2023 to December 2024. According to a 1∶1 ratio and different surgical methods， 58 cases were assigned to Group A （conventional surgical procedure combined with exposure of the recurrent laryngeal nerve via the inferior thyroid artery）， and 58 cases were assigned to Group B （MCDT combined with RLN）， making a total of 116 cases. Both groups were followed up for 6 months after surgery. The short-term efficacy （follow-up for 6 months）， perioperative indicators （including vocal cord function and thyroid function before and 6 months after surgery）， trauma stress indicators （before and 1 day after surgery）， and complications （during the follow-up period） of the two groups were compared. Results After 6 months of follow-up， the total effective rate of group B was 94.83%， which was higher than that of group A （79.31%， P < 0.05）. The length of hospitalization in group B was shorter than that in group A （P < 0.05）. Compared with the pre-surgery state， 6 months after surgery， both groups showed a decrease in amplitude perturbation， fundamental frequency perturbation， normalized noise energy （NNE）， and serum levels of thyroid stimulating antibody （TSAb）， thyroid stimulating blocking antibody （TSBAb）， and thyroid stimulating hormone receptor antibody （TRAb）， with lower values in group B. Both groups showed an increase in harmonic noise ratio （HNR） and a decrease in serum parathyroid hormone （PTH） levels， with higher values in group B （P < 0.05）. Both groups showed a decrease in serum thyroid stimulating hormone （TSH） levels， but there was no significant difference between the two groups （P > 0.05）. Compared with the pre-surgery state， the levels of serum trauma stress indicators increased in both groups 1 day after surgery， but the values in group B were lower （P < 0.05）. During the follow-up period， the incidence of complications in group B was lower （P < 0.05）. Conclusion The combination of MCDT and RLN can help shorten the hospitalization time， reduce traumatic stress， improve the vocal cord function and thyroid function in patients with DTC， thereby enhancing the clinical efficacy and ensuring high safety.

Key words: differentiated thyroid cancer, meticulous capsule dissection technique, recurrent laryngeal nerve, trauma stress indicators