甲状腺微小乳头状癌术中显露喉返神经的临床分析

Protection of the recurrent laryngeal nerve in operation for small papillary thyroid carcinoma

目的探讨乳头状甲状腺癌术中辅以喉返神经显露的临床效果。方法选取甲状腺微小乳头状癌患者112例,随机分为喉返显露组和对照组,每组56例。对照组患者采用常规手术治疗,喉返显露组患者在此基础上应用喉返神经检测仪辅助手术。应用SPSS 20.0软件包进行分析,手术时间、术中出血量、清除淋巴结数、术后引流量等计量资料以（±s）表示,采用t检验;喉返神经损伤率等计数资料采用χ~2检验。P〈0.05为差异具有统计学意义。结果喉返显露组患者手术时间低于对照组（P〈0.05）,但术中出血量和淋巴结清扫数目差异无统计学意义（P〉0.05）。喉返显露组总引流量为（40.3±8.5）ml少于对照组（51.2±12.3）ml（t=5.456,P〈0.01）;喉返显露组患者暂时性RLN瘫痪率为1.8%（1/56）显著低于对照组的12.5%（7/56）（χ~2=4.967,P〈0.05）差异均有统计学意义。结论喉返神经显露技术在甲状腺微小乳头状癌根治术中具有良好应用效果,有效缩短手术时间并保护喉返神经。

Objective To investigate the clinical outcome of intraoperative exposure of the recurrent laryngeal nerve in the surgical treatment of papillary thyroid carcinoma. Methods 112 patients with thyroid papillary carcinoma were randomly divided into an observation group and a control group,with 56 patients in each group. The control group was treated with conventional surgical treatment, and the observation group was treated with a recurrent laryngeal nerve detector. SPSS 20. 0 software package was used to analyze the operation time,bleeding volume,lymph nodes,and postoperative drainage volume.Other data were expressed by mean ± SD and examined by Student＇s t test. The accumulated data including the rate of recurrent laryngeal nerve injury were examined by the Chi- square test. P〈0. 05 was considered as statistically significant. Results The operation time of the observation group was significantly lower than that of the control group（ P〈0. 05）,but there was no significant difference in blood loss and lymph node dissection（ P〈0. 05）. The drainage volume（ 40. 3 ± 8. 5） m L in the observation group was significantly less than（ 51. 2 ± 12. 3） ml in the control group（ t = 5. 456,P〈0. 01）. In the observation group,the rate of temporary RLN paralysis was 1. 8%（ 1 /56）,which was significantly lower than 12. 5%（ 7 /56） in the control group（ χ~2= 4. 967,P〈0. 05）. Conclusion The exposure of the recurrent laryngeal nerve is effective in the operation for thyroid papillary carcinoma,which can shorten the operation time and protect the recurrent laryngeal nerve.