无注气腔镜下甲状腺手术中喉返神经的显露及保护

Technique of reveal and protection of recurrent laryngeal nerve in gasless video-assisted thyroidectomy

目的探讨经胸前入路无注气腔镜下甲状腺切除术中显露喉返神经的可行性。方法对359例甲状腺疾病患者行胸前入路无注气腔镜下甲状腺切除术(腔镜组),术中仔细操作显露喉返神经,并与568例行甲状腺开放手术常规显露喉返神经患者(开放组)进行比较,分析其疗效及术后并发症情况。结果所有患者均顺利完成手术。术后复查B超患侧均无腺体残留。腔镜组6例(1.7%)、开放组10例(1.8%)术后出现暂时性声音嘶哑,两组比较差异无统计学意义,P>0.05。腔镜组均于锁骨下4～5 cm处见一3.5～4 cm斜行切口瘢痕,无明显牵扯感,颈部无瘢痕;开放组颈部均可见4～5.6 cm切口瘢痕。结论在无注气腔镜下甲状腺切除术中显露喉返神经是可行和安全的,且颈部无瘢痕不影响美观。

Objectives This study was performed to compare with recurrent laryngeal nerve （ RLN ） injury rate of endoscopic thyroidectomy and conventional thyroidectomy and evaluate the technique of reveal and protection of RLN in gasless endoscopic thyroidectomy by the anterior chest wall approach. Methods Three hundred and fifty-nine patients with thyroid diseases underwent gasless endoscopic unilateral thyroidectomy by the anterior chest wall approach. The clinical characteristics, complications, and postoperative outcomes of pa- tients were analyzed, comparing with 568 patients with thyroid diseases underwent conventional thyroidectomy. Result Three hundred and fifty-nine patients underwent unilateral endoscopic thyroidectomy and generally dis-sected to find the RLN. There were 6 patients of postoperative transient RLN palsy （ 1.67% ）. In conventional thyroidectomy group, there were 10 patients of postoperative transient RLN palsy （ 1.76% ） , P 〉 0.05. Con-clusion In gasless video-assisted thyroideetomy by the anterior chest wall approach, reveal of recurrent laryn-geal nerve is feasible and safe, and meet the requirements of aesthetics as well.