甲状腺手术中使用超声刀对喉返神经的保护作用

Association of the use of harmonic scalpel in thyroidectomy with recurrent laryngeal nerve Protection

目的比较超声刀行甲状腺手术与传统甲状腺手术对喉返神经的保护作用。方法 263例患者采用超声刀行甲状腺手术,228例采用传统方法行甲状腺手术,对比两种手术方法对喉返神经的保护、术后喉返神经损伤并发症发生情况,评估超声刀在预防喉返神经损伤方面的优缺点。结果 263例甲状腺手术使用超声刀,2例因热损伤出现暂时性声嘶,均在3个月内恢复;传统方法出现声嘶并发症7例,其中3例术中被缝扎,松解后均在术后1周内缓解,3例术后3个月至半年发音恢复正常,1例术后出现声嘶超过1年以上未好转。结论超声刀行甲状腺手术可减少术中出血,有利于喉返神经行程的辨认。

Objective To investigate whether the use of harmonic scalpel in thyroidectomy was beneficial for recurrent laryngeal nerve protection. Methods Four hundred and ninty-one patients underwent thyroidectomy with harmonic scalpel or conventional hemostasis. The incidences of recurrent laryngeal nerve injury after operation were compared between two groups. Results In 263 patients who underwent thyroidectomy with harmonic scalpel, two cases presented as transient hoarseness after operati- ons, due to thermal burning the nerve, which recovered in three months. In 228 patients who underwent thyroideetomy with conventional hemostasis, seven cases presented as hoarseness after operations, among which, three cases got recovery in one week, after the ligated nerve was promptly relaxed during operation. three cases got recovery in three months to one year, while another one did not get any recovery one year after operation. Conclusions The use of harmonic scalpel in thyroidectomy is beneficial for blood loss reduction and recurrent laryngeal nerve affirmation. Avoiding the thermal burning of ultrasonic knife near thyroid cartilage is helpful in recurrent laryngeal nerve protection.