高风险甲状腺手术中显露喉返神经技术的价值

Value of exposure of recurrent laryngeal nerve during high-risk thyroid operation

目的 探讨显露喉返神经（RLN）技术在高风险甲状腺手术中预防RLN损伤的价值.方法 分析325例高风险甲状腺手术病例资料,根据术中是否显露RLN,分为显露组、非显露组,按术中涉及的RLN数量计算RLN损伤率,比较两组RLN损伤率的差异.根据术中是否应用神经监测仪将显露组分为辅助显露组和常规显露组,比较两组RLN损伤率及住院费用的差异.结果 显露组、非显露组RLN损伤率分别为2.25％（8/355）、8.00％（14/175）,暂时性RLN损伤率分别为1.97％ （7/355）、5.14％ （9/175）,永久性RLN损伤率分别为0.28％ （1/355）、2.86％ （5/175）,两组差异均有统计学意义（P＜0.05）.辅助显露组的暂时性RLN损伤率、永久性RLN损伤率均低于常规显露组,但两组差异无统计学意义（P＞0.05）.辅助显露组与常规显露组住院费用比较差异有统计学意义（P＜0.05）.结论 高风险甲状腺手术术中显露RLN能有效降低RLN损伤率,术中应用神经监测仪辅助显露RLN不能进一步降低RLN损伤率.

Objective To study the value of the technique of exposure of recurrent laryngeal nerve （RLN） in preventing RLN injury during high-risk thyroid operation.Methods Three hundred and twentyfive patients subject to high-risk thyroid operation were analyzed retrospectively.The patients were divided into exposure group and un-exposure group according to whether to expose the RLN during operation.RLN injury rate of the two groups was calculated according to the number of involved RLN during operation.The RLN injury rate was compared.The exposure group was divided into auxiliary exposure subgroup and routine exposure subgroup according to whether to use intraoperative neuromonitoring.The RLN injury rate and hospitalization expenses were compared between routine exposure subgroup and auxiliary exposure subgroup.Results The RLN palsy rate in exposure group and un-exposure group was 2.25% （8/355） and 8.00% （14/175） respectively,while the temporary RLN palsy rate was 1.97% （7/355） and 5.14% （9/175）,and the permanent RLN palsy rate was 0.28% （1/355） and 2.86% （5/175） respectively.The differences were statistically significant （P 〈 0.05）.Temporary RLN palsy rate and permanent RLN palsy rate in auxiliary exposure subgroup were both lower than in routine exposure subgroup,but there was no significant difference （P 〉 0.05）.There was significant difference in hospitalization expenses between routine exposure subgroup and auxiliary exposure subgroup （P 〈 0.05）.Conclusion Exposure of RLN during high-risk thyroid operation can reduce the RLN injury rate,and application of intraoperative neuromonitoring can not decrease RLN injury rate further.