采用精细化被膜解剖+喉返神经显露法行甲状腺腺叶切除452例临床分析

Clinical Analysis of Thyroid Lobectomy by Meticulous Capsular Dissection and Exposure of Recurrent Laryngeal Nerve in 452 Cases

目的探讨采用精细化被膜解剖+喉返神经显露法行甲状腺腺叶切除对甲状旁腺及喉返神经的保护意义。方法回顾性分析笔者所在医院2010年1月至2012年12月期间行甲状腺腺叶切除的452例患者的临床资料。结果 452例患者的手术均顺利完成,无手术死亡病例。平均手术时间为60 min(45～110 min),术中平均失血量为20 mL(5～100 mL)。术后病理学诊断为甲状腺腺瘤193例,结节性甲状腺肿175例,桥本甲状腺炎38例,甲状腺癌46例。术后出现喉返神经损伤4例,其中1例拔出引流管后症状即消失,余3例于术后0.5～3.0个月恢复正常;出现喉上神经损伤2例,症状均在1周内消失;出现一过性甲状旁腺功能损伤5例,经治疗1～5 d后好转,未发生永久性低钙血症。术后因出血再次手术缝扎止血3例,1例为颈前静脉分支出血,1例为甲状腺侧方小动脉出血,1例为甲状腺残端出血。术后1个月发生甲状腺功能减低21例。随访期间,均未见肿瘤复发。结论精细化被膜解剖可以有效保护甲状旁腺的功能及减少喉返神经损伤;常规喉返神经显露是安全可行的,对避免喉返神经的严重损伤具有重要作用。

Objective To explore the clinical significance on protection of parathyroid and recurrent laryngeal nerve（RLN）by meticulous capsular dissection and exposure of RLN in thyroid lobectomy.Methods Clinical data of 452 patients who underwent thyroid lobectomy by meticulous capsular dissection and exposure of RLN in our hospital from Jan.2010 to Dec.2012 were retrospectively analyzed.Results All of the 452 cases underwent thyroid lebectomy successfully without death,and the operative time was 45-110 min（average 60 min）,the blood loss was 5-100 mL（average 20 mL）.The pathological results showed that there were thyroid adenoma in 193 cases,nodular goiter in 175 cases,Hashimoto thyroiditis in 38 cases,thyroid cancer in 46 cases.After operation,4 cases suffered RLN injury,1 of the 4 cases recovered after removal of drainage tube,and other 3 cases recovered during 0.5 to 3.0 months.In addition,2 cases suffered laryngeal nerve injury whose symptoms disappearred within 1 week,5 cases suffered parathyroid founctional damage without permanent hypocalcemia whose symptom had kept 1-5 days after treatment.Three cases were reoperated because of bleeding,including branch of anterior venous bleeding in 1 case,thyroid side arterial tube bleeding in 1 case,and thyroid stump bleeding in 1 case.Twenty one cases suffered hypothyroidism in 1 month after operation,and no recurrence happened during the followed up period.Conclusions Meticulous capsular dissection can effectively protect function of parathyroid and reduce the injury probability of RLN.Exposure of RLN is safe and feasible,which plays an important role in avoiding serious RLN injury.