喉返神经显露在甲状腺良性病变手术中的意义

The clinical implication of exposure of recurrent laryngeal nerve during operation for benign thyroid neoplasm

目的探讨甲状腺良性病变手术中喉返神经(RLN)显露的临床效果。方法将收治的768例甲状腺良性病变患者按手术序号随机分为3组:(1)选择性显露RLN组(选择组,单号根据患者术中情况显露RLN者),106例,即行腺叶全切、背侧腺体不能保留的腺叶次全切或再次手术者RLN选择显露;(2)选择非显露组(非显露组,单号术中不显露RLN者),278例;(3)常规显露组(常规组,双号术中RLN常规显露),384例。结果全组RLN损伤率1.04%(8/768),无永久性损伤和双侧损伤。RLN非显露组损伤率0.72%(2/278),选择组0.94%(1/106),常规组1.30%(5/384),3组间差异无统计学意义(P>0.05);非显露组手术时间(78.96±17.60)min,显著短于选择组的(89.05±18.50)min和常规组的(93.44±18.90)min(P<0.05);非显露组术中出血量(42.73±23.08)mL,显著少于选择组的(56.47±24.43)mL和常规组的(62.03±27.46)mL(P<0.05)。结论在甲状腺良性病变手术中应根据患者情况决定是否显露RLN。

Objective To explore the clinical effect of exposure of recurrent laryngeal nerve （ RLN ） during operation in patients with benign thyroid neoplasm. Methods Seven hundred and sixty-eight patients with benign thyroid neoplasm admitted between July 2005 and June 2008 were randomly divided into three groups according to the operation procedure ： （ 1 ） For patients with lobectomy or subtotal lobectomy, the dorsum of gland could not be retained or with reoperation, RLN was selectively exposured; （2） 278 cases with non-exposure of RLN ; （ 3 ） 384 patients had routine exposure of RLN. Results Of all the cases, the injury rate of RLN was 1.04% （8/768） , no permanent injury or bilateral RLN injury ouarred. The injury rate of RLN in non-exposure groups was 0. 72% （2/278）, in selective explore groups and routine groups was 0.94% （1/106） and 1. 30% （5/384）, respectively, but. the difference was not significant between the three groups （P 〉 0.05 ）. Operative procedure time was significantly shorter in non-exposure groups than that in selective group and routine group[ （78.96 ± 17.60） min vs. （ 89.05 ± 18.50） min and （93.44 ± 18.90 ）min ,P 〈 0.05].The bood loss during operation was significantly less in non-exposure group than that in selective group and routine group[ （42.73 ±23.08）mL vs. （56.47 ±24.43）mL and （62.03± 27.46 ） mL, P 〈 0. 05 ] . Conclusions Exposure and non-exposure of the RLN should be determined by the patient＇s condition of benign thyroid neoplasm during operation.