甲状腺手术喉返神经损伤的原因及防治方法研究

Study on causes and prevention of recurrent laryngeal nerve injury in thyroid surgery

目的探讨甲状腺手术中喉返神经(recurrent laryngeal nerve,RLN)损伤的原因及防治策略。方法回顾性分析1 893例甲状腺患者的临床资料,根据RLN损伤情况分为损伤组(40例)和未损伤组(1 853例)。对损伤相关因素进行Logistic回归分析,并针对危险因素提出有效防治措施。结果喉返神经总损伤率为2.11%。两组在甲状腺恶变、多次手术、手术范围等方面甲状腺手术中RLN损伤率有统计学意义(P<0.05)。Logistic分析显示,甲状腺恶变、多次手术及甲状腺广泛性手术是RLN损伤的独立危险因素。结论对甲状腺良性肿瘤且病变范围较小的患者,手术方式以不显露RLN、保留部分甲状腺背侧组织更为安全可靠,可降低手术时对RLN的损伤。而对于广泛性甲状腺切除术,术中应常规显露RLN可行。

Objective To investigate the causes and prevention strategies of laryngeal nerve recurrent（ RLN） injury in thyroid surgery. Methods In the clinical data,1,893 cases of thyroid were analyzed retrospectively,According to the damage of RLN,cases were divided into injury group（ 40 cases） and noninjured group（ 1853 cases）. Logistic regression analysis was performed on the injury related factors,and put forward the prevention and control measures against the risk factors. Results The total injury rate of recurrent laryngeal nerve was 2.11%. Two groups of thyroid in thyroid malignant,multiple surgeries and the surgical extent of intraoperative RLN injury rate was statistically significant（ P〈0. 05）. Logistic analysis showed that thyroid malignancy,multiple surgeries and thyroid surgery was widely independent risk factors for RLN damage.Conclusions For patients with benign thyroid tumor and smaller lesion,the operation method is safe and reliable with no exposure to RLN and partial thyroidectomy,which can reduce the injury of the recurrent laryngeal RLN.For extensive thyroidectomy,exposed RLN is feasible in operation.