甲状腺术中显露喉返神经的临床价值

Clinical value of expose recurrent laryngeal nerve(s) in thyroid disease surgery

目的探讨甲状腺术中显露喉返神经对减少其损伤的价值。方法回顾性分析2012年6月—2014年1月该科119例甲状腺手术患者资料,按术中是否显露喉返神经将资料分为解剖组(79例)和未解剖组(40例),根据病变范围采用广泛性切除术或保守性切除术,分析不同组别及不同术式喉返神经损伤情况。结果解剖组术后3例发生暂时性喉返神经损伤,无永久性喉返神经损伤发生,未解剖组术后6例发生喉返神经损伤,其中2例为永久性损伤。两组总的喉返神经损伤率差异有统计学意义(χ2=4.77,P<0.05),在广泛性切除术中,两组差异有统计学意义(χ2=12.37,P<0.05),在保守性切除术中,两组差异无统计学意义(χ2=0.06,P>0.05)。结论术中显露喉返神经是减少喉返神经损伤的有效方法,对于范围较小的良性病变行保守性切除术时,术中保留部分甲状腺背侧组织,不显露喉返神经亦是安全可靠的。

Objective To investigate the clinical value of expose recurrent laryngeal nerve （ s） （ RLN） which may reduce its injury in thyroid diseases surgery .Methods The clinical data of 119 cases treated from June 2012 to January 2014 were analyzed retrospective-ly.Among these cases ,79 underwent expose of the RLN as anatomy group ,while those who did not undergo expose of the RLN as non -anatomy group（n=40）.According to its lesion size,extensive or conservative thyroidectomy was used and the differences of RLN injury in different groups or with different surgeries were analyzed .Results Temporary unilateral RLN palsies occurred in 3 patients in anato-my group but no permanent RLN injury case was found .There were 4 cases of temporary RLN injuries and 2 cases of permanent RLN injuries in non-anatomy group.The overall differences between the two groups were statistically significant （χ2 =4.77,P〈0.05）.In ex-tensive thyroidectomy,exposure of RLN during operation may reduce the risk of nerve injury （χ2 =12.37,P〈0.05）.In conservative surgery,the rates of nerve injury were not significantly different in patients with and without identification of the nerve during thyroidec -tomy（χ2 =0.06,P〉0.05）.Conclusions For safe thyroid surgery,recurrent laryngeal nerve （s） should be routinely exposed in its entire course,which maybe is also safe without exposure of RLN for smaller benign lesion using conservative thyroidectomy .