甲状腺三种术式对喉返神经影响的对比观察

Effect of three types of thyroidectomy on recurrent laryngeal nerve:Comparative study of

目的探讨喉返神经(RLN)在甲状腺三种不同术式中可能损伤的临床意义。方法回顾性分析2009年6月至2012年5月346例次甲状腺手术治疗资料,按病种需要采用的手术方法分3组:甲状腺全切除术分别为:RLN解剖组(A组,83例次)和被膜精细化解剖组(B组,107例次);甲状腺次全切除术为保留甲状腺后背膜组(C组,156例次)。对比3组RLN永久性损伤率和暂时性损伤率。结果患者术后均获门诊随访,随访率100%,随访时间5～41个月,平均22.6个月,无1例死亡。永久性RLN损伤率显示,B组明显高于其他两组(χ2=6.591,P<0.05),差异有统计学意义;A组和C组之间(χ2=0.038,P>0.05)差异无统计学意义。暂时性RLN损伤率显示,A组明显高于其他两组(χ2=5.720、χ2=9.598,P<0.05),差异有统计学意义。结论甲状腺全切除术常规解剖显露RLN可以避免其损伤发生,保留甲状腺后被膜甲状腺次全切除术是一种安全的术式,无解剖RLN的必要。

Objective To investigate the possible surgical injury of recurrent laryngeal nerve （RLN） in three types of thyroidectomy. Methods Retrospective analysis were performed in 346 eases of thyroidectomy from June 2009 to May 2012. Patients with thyroid carcinoma were divided 3 groups： RLNs dissection group （group A, 83 cases ） and meticulous capsular dissection group （group B, 107 cases） after total thyroidectomy, while posterior capsular reserved group （group C, 156 cases） after subtotal thyroidectomy. The incidence of RLNs permanent and temporary injury were compared between 3 groups. Results All of the patients （ 100% ） were followed up after the operation in out-patient department from 5 to 41months, with the average of 22.6 months with no perioperative death. In group B, incidence of RLNs permanent injury, was significantly higher than those in other 2 groups （X2 = 6. 591, P 〈 O. 05 ） , however there was no statistical significance between group A and C （X2 = 0. 038, P 〉 0. 05 ）. In group A, the incidence of RLNs temporary injury was significantly higher than those in other 2 groups respectively （X2 = 5. 720, X2 = 9. 598, P 〈 0. 05 ）. Conclusion During total thyroidectomy for thyroid diseases, the dissection of RLNs could help to avoid the injury of RLNs permanent injury. It is a safe appraoch to reserve posterior capsular in subtotal thyroidectomy without the need to dissect the RLNs.