良性甲状腺肿瘤手术喉返神经损伤原因及预防

Causes and prevention of recurrent laryngeal nerve injury in surgery of benign thyroid tumor

目的探讨良性甲状腺肿瘤手术中喉返神经损伤的预防,以期降低手术后喉返神经损伤的发生率。方法将480例手术前诊断为甲状腺良性肿块患者随机分为解剖喉返神经组(232例)与未解剖喉返神经组(248例),比较两组的喉返神经损伤发生率。结果解剖喉返神经组神经暂时性损伤率是1.74%(4/232),永久性损伤率是0.86%(2/232),没有解剖喉返神经组暂时性损伤率6.45%(16/248),永久性的损伤率2.82%(7/248),两组差异有统计学意义(P<0.05)。结论良性甲状腺肿瘤手术中精细的解剖喉返神经并加以保护能减少喉返神经的损伤,建议行甲状腺大部切除术、腺叶切除术时应常规精细解剖喉返神经并加以保护。

Objective To investigate the preventative measures against recurrent laryngeal nerve（RLN） injury in surgery of benign thyroid tumor,with the purpose of reducing the incidence of RLN injury.Methods Four hundred and eighty cases of benign thyroid tumor diagnosed before surgery were randomly divided into two groups,of which,232 cases underwent RLN dissection（group A） and the other 248 cases did not undergo RLN dissection（group B）.The occurrence rate of RLN injure was compared between the 2 groups.Results Temporary and permanent nerve injury rates were 1.72%（4/232） and 0.86%（2/232） respectively in group A,and were 6.45%（16/248） and 2.82%（7/248） respectively in group B.The differences of both rates between the two groups were statistically different（P0.05）.Conclusions Meticulous surgical dissection and take care of RLN during surgery for benign thyroid diseases can reduce the incidence of RLN injury.Thus RLN dissection is recommended to be performed routinely during operation of near-total thyroidectomy or lobectomy.