喉返神经损伤在甲状腺癌根治术中的原因及防治体会

Causes and Prevention of Recurrent Laryngeal Nerve Injury During Thyroidec-tomy Operation in Patients with Cancer of Thyroid

目的:探索喉返神经损伤在甲状腺癌根治手术中的原因及防治措施。方法:分析2008年1月—2013年5月47例行根治性手术治疗的甲状腺癌患者的临床资料,总结引起喉返神经损伤的主要原因、预防措施及损伤后处理方法。结果:47例甲状腺癌患者中,喉返神经损伤5例,其中永久性损伤2例,1例为双侧损伤,暂时性损伤3例,其中1例行气管切开,带管出院,3个月内来院拔出气管导管,恢复功能,定期复查无不适。损伤原因经过回顾性分析,考虑以下几种:此类手术实施过少,解剖层次不清,手术很容易误伤;术野止血不彻底致使视野不清,遇到出血时血泊中盲目钳夹止血误伤;切口过小过度牵拉,特别是拉钩过度过深,使喉返神经被牵拉;出血时缝扎或缝合残余腺体过深;电刀功率过大或距神经较近导致热传导损伤;生物胶止血时直接接触神经导致化学损伤;助手配合失当等。不同术式的损伤发生率也有所不同。结论:甲状腺癌根治切除中喉返神经损伤是常见并发症。熟悉解剖结构、熟练而规范的操作、充分良好的喉返神经的暴露,手术野充分清楚显露、助手很好的配合仍是预防的关键。

Objective：To explore the recurrent laryngeal nerve injury in thyroid cancer radical surgery causes and pre- vention measures. Methods：A retrospective analysis from January 2008 to May 2013 47 underwent radical surgery for thyroid cancer patients with clinical data, summarize the main cause of recurrent laryngeal nerve injury, injury preven- tion and treatment methods. Results：47 cases of thyroid cancer patients, recurrent laryngeal nerve injury in five cases, including permanent injury in 2 cases, 1 case of bilateral injury, temporary injury in 3 cases, including a routine tracheot- omy, with a pipe and discharged in March to the hospital within the endotracheal tube removed, restore function. Injury After retrospective analysis, consider the following： implementation of such operations is few, anatomical level is un- clear; operative field hemostasis resulting in poor visibility, blind pool of blood hemostasis accidental injury; incision is few to make excessive traction, making throat recurrent nerve is pulled; bleeding suture or suture residual glandular too deep; electrosurgical power is too large or thermal conductivity resulting from nerve damage nearer; biological glue he- mostasis direct contact with nerve cause chemical damage; assistant mismatch and so on. Different surgical injury inci- dence rate is also different. Conclusion： Radical resection of thyroid cancer in the recurrent laryngeal nerve injury re- mains a common complication. Familiar with the anatomy, skilled and standardized operations, adequate exposure of the re- current laryngeal nerve, reveal sufficiently clear surgical field, the assistant is still very good with the key to prevention.