甲状腺手术中喉返神经损伤的预防

Prevention of recurrent laryngeal nerve injury during thyroid operation

目的通过回顾性分析,评价甲状腺手术中解剖喉返神经的必要性。方法将手术治疗的甲状腺疾病患者512例按术中是否解剖喉返神经分为解剖组和未解剖组,比较两组间喉返神经损伤的发生率。结果全组解剖喉返神经组189例,术后出现声嘶3例(1.59%),未解剖神经组323例,术后出现声嘶5例(1.55%)。两组差异无统计学意义(P>0.05);但在存在有喉返神经损伤高危因素的患者中解剖与未解剖神经患者神经损伤率则有差异(1.02%vs.3.95%,P<0.05)。结论是否解剖喉返神经应根据具体情况决定,对大多数甲状腺良性病变尽可能不暴露喉返神经,但对于巨大甲状腺肿瘤、二次或多次手术及甲状腺癌应暴露喉返神经。

Objective To retrospectively evaluate the necessity to dissect the recurrent laryngeal nerve in operation of thyroid gland. Methods From Jan 2004 to Jan 2009, there were 512 patients in our hospital who underwent operation of thyroid gland, and they were divided into two groups aecording to whether or not the recurrent laryngeal nerve was dissected during the operation. The rate of injury of recurrent laryngeal nerve between the two groups was compared. Results Among the 189 cases in dissection of recurrent laryngeal nerve group, 3 cases （ 1.59% ） had hoarseness after operation, and in the 323 cases without dissection of the recurrent laryngeal nerve group, 5 cases （ 1.55 % ） had hoarseness after operation, but the difference was not significant （ 1. 59% vs. 1. 55% ）. However, in the high risk cases between the two groups, the difference was significant（ 1. 02% vs. 3. 95% ）. Conclusions Whether oe not to dissect the recurrent laryngeal nerve should be decided by the specific circumstances. For most benign lesions, one should, if possible, not expose the recurrent laryngeal nerve; but for large thyroid neoplasms, second or multiple operations and thyroid cancer, exposure of recurrent laryngeal nerve is necessary.