腔镜辅助下巨大甲状腺肿物手术中喉返神经监测的临床效果分析

Clinical Efficacy of Recurrent Laryngeal Nerve Monitoring in Video-Assisted Thyroidectomy for Huge Thyroid Nodules

目的探讨喉返神经监测在腔镜辅助下巨大甲状腺肿物手术中的应用效果。方法回顾性分析2013年1月至2015年6月期间在腔镜辅助下治疗的158例巨大甲状腺肿物患者的临床资料,其中喉返神经监测79例(喉返神经监测组),喉返神经未监测79例(喉返神经未监测组)。对比分析2组在手术时间、术中出血量、术后引流量、术后住院时间、术后暂时性及永久性喉返神经损伤发生情况之间的差异。结果 158例患者均顺利完成腔镜辅助颈部小切口甲状腺手术。与喉返神经未监测组比较,喉返神经监测组的手术时间(min)明显缩短(76.2±23.4比89.2±29.8,P<0.05),术中出血量(m L)和术后引流量(m L)均明显减少(术中出血量:16.3±13.6比20.6±10.7,P<0.05;术后引流量:20.7±9.6比25.5±9.1,P<0.05),但2组的术后住院时间(d)比较差异无统计学意义(3.2±1.3比3.3±1.9,P>0.05)。术后随访8周,喉返神经监测组暂时性神经损伤发生率明显低于喉返神经未监测组〔5.6%(5/90)比21.8%(17/78),P<0.05〕,但永久性神经损伤发生率在2组间比较差异无统计学意义〔0(0/90)比1.3%(1/78),P>0.05〕。结论腔镜辅助巨大甲状腺结节手术中应用喉返神经监测技术可有效减少神经损伤发生率,缩短手术时间。

Objective To investigate effect of recurrent laryngeal nerve monitoring in video-assisted thyroidectomy for huge thyroid nodules. Methods The clinical data of 158 patients with huge thyroid nodules underwent videoassisted thyroidectomy from January 2013 to June 2015 were analyzed retrospectively, the recurrent laryngeal nerves were monitored in 79 cases（monitoring of recurrent laryngeal nerve group） while the recurrent laryngeal nerves were not monitored in the other patients（non-monitoring of recurrent laryngeal nerve group）. The operative time, blood loss, postoperative drainage, postoperative hospital stay, and the incidences of transient and permanent recurrent laryngeal nerve injury were observed between these two groups. Results The video-assisted miniincision thyroidectomy was successfully completed in these 158 cases. Compared with the non-monitoring of recurrent laryngeal nerve group, the operative time（min） was shorter（76.2±23.4 versus 89.2±29.8, P〈0.05）, the blood loss and the postoperative drainage were less（16.3±13.6 versus 20.6±10.7, P〈0.05; 20.7±9.6 versus 25.5±9.1, P〈0.05） in the monitoring of recurrent laryngeal nerve group. But the postoperative hospital stay（d） had no significant difference between the monitoring of recurrent laryngeal nerve group and the non-monitoring of recurrent laryngeal nerve group（3.2±1.3 versus 3.3±1.9, P〉0.05）. Eight weeks later, the incidence of transient recurrent laryngeal nerve injury in the monitoring of recurrent laryngeal nerve group was significantly lower than that in the non-monitoring of recurrent laryngeal nerve group〔 5.6%（5/90） versus 21.8%（17/78）,P〈0.05〕, while the incidence of permanent nerve injury had no statistical difference between the monitoring of recurrent laryngeal nerve group and the non-monitoring of recurrent laryngeal nerve group 〔 0（0/90） versus 1.3%（1/78）,P〉0.05〕. Conclusion Recurrent laryngeal nerve monitoring under video-assisted thyroidectomy for huge thyroid nodules could effectively reduce incidence of nerve injury and shorten operation time.