甲状腺手术操作方式和喉上神经外支损伤的关系

Relationship Between External Branch of Superior Laryngeal Nerve Injury and Surgical Approach

目的研究麻醉方式、手术范围、超声刀应用、喉上神经外支(EBSLN)显露等手术操作方式对EBSLN损伤的影响,探讨开放性甲状腺手术后EBSLN损伤的危险因素和预防方法。方法回顾性分析2009年1月至2012年6月期间于笔者所在医院普外科行开放性甲状腺手术的985例患者的临床资料,分析EBSLN损伤的影响因素。结果 985例患者术后发生EBSLN损伤26例(2.6%),未发生EBSLN损伤959例(97.4%)。logistic回归分析结果显示,手术范围及显露EBSLN均与EBSLN损伤有关(P<0.050),行扩大性手术(OR=4.536,P=0.004)及未显露EBSLN者(OR=0.126,P=0.044)的EBSLN损伤率较高;而EBSLN损伤与年龄(OR=1.108,P=0.823)、性别(OR=0.604,P=0.260)、肿块性质(OR=1.871,P=0.186)、麻醉方式(OR=0.659,P=0.372)及超声刀应用(OR=0.473,P=0.248)均无关。结论在开放性甲状腺手术中,手术范围以及EBSLN暴露均是EBSLN损伤的独立影响因素,术中显露并注意保护EBSLN,对避免EBSLN损伤具有重要意义。

Objective To explore the relationship between external branch of superior laryngeal nerve（EBSLN） injury and the approachs of surgery in open thyroidectomy, and to summarize the preventive methods. Methods The clinical data of 985 patients who had consecutively underwent open thyroidectomy from January 2009 to June 2012 were retrospectively analyzed, to explore the relationship between EBSLN injury and the approachs of surgery in open thyroidectomy. Results The overall incidence of EBSLN injury was 2.6%（26/985）, and 959 patients（97.4%） didn＇t suffered from EBSLN injury. Results of logistic regression showed that the extent of surgery（OR=4.536, P=0.004） and identification of the EBSLN（OR=0.126, P=0.044） were influence factors of EBSLN injury after open thyroidectomy, but age（OR=1.108, P=0.823）, gender（OR=0.604, P=0.260）, benign or malignant tumor（OR=1.871, P=0.186）, anesthesia methods（OR=0.659, P=0.372）, and the application of ultrasonic scalpel（OR=0.473, P=0.248） were not associated with EBSLN injury. Conclusion In open thyroidectomy, the extent of surgery and identification of EBSLN are the independent factors of EBSLN injury, which are important to avoid EBSLN injury.