甲状腺良性病变手术显露喉返神经指征探讨

The exploration of the operation of thyroid benign lesions of exposure of recurrent laryngeal nerve indication

目的探讨甲状腺良性病变手术显露喉返神经的指征。方法运用随机数字表法对2005年6月至2010年6月在内蒙古医学院附属医院肿瘤外科住院治疗的348例需手术治疗的甲状腺良性病变患者进行分组,观察组(174例,男79例,女95例)采用常规暴露喉返神经术式,对照组(174例,男76例,女98例)则采用非暴露喉返神经术式,并于术后3个月对患者进行随访。结果观察组和对照组喉返神经损伤发生率分别为1.15%(2/174)和5.17%(9/174),两组间喉返神经损伤发生率差异有统计学意义(χ2=4.600,P<0.05)。对甲状腺良性病变手术喉返神经损伤的患者进行3个月随访,观察组患者的喉返神经功能均恢复正常,对照组9例发生喉返神经损伤中仅2例患者的喉返神经功能恢复正常,两组间患者喉返神经功能恢复率差异有统计学意义(χ2=4.278,P<0.05)。结论在甲状腺良性病变手术术中,合理显露并注意保护喉返神经,甲状腺一侧叶需大切或全切,或甲状腺肿物位于甲状腺中下极或者位于甲状腺后背膜是常规暴露喉返神经的指征。可有效避免喉返神经损伤,保障患者安全。

Objective To explore the operation of thyroid benign lesions of exposure of recurrent laryngeal nerve indication.Methods A random number table of June 2005 to June 2010 in department of oncolgy surgery,the first affiliated hospital,Inner Mongolia Medical College was hospitalized 348 patients required operation for treatment of thyroid benign lesions.In patients with grouping,the observation group was treated with routine exposure of recurrent laryngeal nerve in operation,the control group using an exposure of recurrent laryngeal nerve surgery,and the patients were followed up for 3 months after operation.Results In the observation group and the control,recurrent laryngeal nerve injury occurred in 1.15%(2/174) and 5.17%(9/174),two groups of recurrent laryngeal nerve injury incidence had statistically significant difference(χ2=4.600,P<0.05).The patients were followed up for 3 months.The recurrent laryngeal nerve function of the observation group were normal,2 in 9 cases in the control group suffered from recurrent laryngeal nerve injury were with recurrent laryngeal nerve function returned to normal.In the two groups,the recovery rate of recurrent laryngeal nerve function had significant difference(χ2=4.278,P<0.05). Conclusions In benign thyroid lesions operation,we should reasonable exposure and pay attention to the protection of the recurrent laryngeal nerve.In thyroid side,it is need to all or most of the resection,or thyroid tumor located in the lower pole of thyroid or thyroid membrane is located in back of routine exposure of recurrent laryngeal nerve indications.It can effectively prevent recurrent laryngeal nerve damage,ensure the safety of patients.