甲状腺术中显露喉返神经对致喉返神经损伤的影响

Exposure of the recurrent laryngeal nerve during thyroid operation and its influence on the never injury

目的探讨甲状腺术中显露喉返神经(RLN)的手术方法以及对RLN损伤的影响。方法选取2008年12月至2010年12月行甲状腺术患者132例,设为对照组,术中未常规显露RLN;选取2011年1月至2012年12月行甲状腺术患者106例,设为观察组,术中常规显露RLN。比较两组患者的手术时间、解剖RLN所需时间,手术方式、术后病理结果及术后RLN损伤情况。结果观察组与对照组手术时间分别为(65.2±6.1)分钟、(57.8±5.6)分钟,差异具有统计学意义(P<0.05);其中观察组解剖RLN所需时间平均为(6.8±2.1)分钟。两组手术方式、术后病理结果均无统计学差异(P>0.05)。观察组与对照组术后RLN损伤发生率分别为1.89%、6.82%,差异具有统计学意义(P<0.05)。术后6个月,观察组与对照组RLN永久麻痹发生率分别为0.00%、5.30%,差异具有统计学意义(P<0.05)。结论在充分掌握RLN解剖特点、熟悉手术操作技巧的基础上,术中显露RLN可有效降低甲状腺手术中RLN损伤的发生率,对预防甲状腺手术中RLN损伤具有一定的指导借鉴意义。

Objective To explore the method of showing recurrent laryngeal nerve （RLN） during thyroid operation and its influence on RLN injury. Methods 132 cases undergoing thyroid operation from December 2008 to December 2010 were included as control group, without RLN exposure. 106 cases undergoing thyroid operation from JanualT 2011 to December 2012 were included as observation group, with RLN exposure. Two groups＂ operation time, RLN exposure time, operation method, postoperative pathological results and postoperative RLN injury were compared. Re- sults Observation group and control group＇s operation time were （65.2＋6.1） rain and （57.8~5.6） min, there was statistical difference （t=4.61 ,P〈0.05）, The observation group＇s RLN exposure time was （6.8-＋2.1）min. There were no statistical difference on operation method, postoperative pathological re- suits between two groups （P〉0.05）. Postoperative RLN injury rate in observation group and control group were 1.89%, 6.82%（X2=4.09,P〈0.05）. 6 months after operation, RLN permanentparalysis rate in observation group and control group were 0%, 5.30% （X2=3.17,P〈0.05）. Conclusion On the basis of fully understanding of RLN anatomic features, exposure of RLN during thyroid operation can effectively reduce the incidence of RLN in- jury.