胸前入路免注气内镜甲状腺手术中锁骨上神经的保护价值

The significance of preservation of the supraclavicniar nerve in endoscopic thyroidectomy via gasless anterior chest approach

目的 初步探讨胸前入路免注气内镜甲状腺手术后胸部皮肤感觉改变情况与术中保护颈丛锁骨上神经的关系.方法 回顾性分析2015年1月至2016年9月接受单侧胸前入路免注气内镜甲状腺切除术患者168例,其中术中完整保留颈丛锁骨上神经内支者110侧（保护组）,出现颈丛锁骨上神经内支损伤或未能清晰暴露保护者58侧（未保护组）,两组于术后1-12个月随访,以Semmes-Weinstein单丝（SWM）试验和VAS评分评估胸部感觉变化,以Mann-Whitney U检验对比两组得分,并以卡方检验对比各时段两指标恢复正常的比例.结果 胸部感觉Semmes-Weinstein单丝试验得分及VAS得分保护组优于未保护组.分时段统计,保护组各区SWM得分恢复正常比例均高于未保护组,前者在7-9个月基本完全恢复正常,未保护组10-12个月时大部分恢复（锁骨上区和锁骨下区分别为69.2%和61.5%）.VAS得分在术后1-3个月和10-12个月时两组恢复比例差异无统计学意义,其余时段保护组高于未保护组.结论 术中保留颈丛锁骨上神经有利于胸前入路免注气内镜甲状腺切除术后胸前皮肤感觉的恢复,提高患者的生活质量.

Objective To evaluate the significance for the preservation of the supraclavicular nerve in endoscopic thyroidectomy via gasless anterior chest approach .Methods We retrospectively evaluated 168 patients who underwent unilateral endoscopic thyroidectomy via gasless anterior chest approach , with preservation of the medial branch of the supraclavicular nerve in 110 patients and not in other 58 patients . Semmes-Weinstein monofilament （SWM） test and a visual analogue scale （VAS） were used to assess the recovery of sensation in anterior chest within 1-12 months postoperatively .Difference in the scores of SWM or VAS between groups was tested with Mann-Whitney U test, and the rates of SWM and VAS scores returning to normal levels in individual periods after surgery was compared with Chi -square test.Results The preserved group showed more favorable results than the non-preserved group in both SMW and VAS scores .Compared to control group , SWM score in preserved group possessed a higher rate recovery to normal level at any period after operation , which was close to complete normality in 7-9 months postoperatively , and SWM score in non-preserved group was still partially normal in 10-12 months from surgery .Preferable results for VAS were also found in the preserved group , except no significant difference in VAS between groups in1-3 months or 10-12 months after operation .Conclusion Preservation of the medial branch of the supraclavicular nerve in endoscopic thyroidectomy via gasless anterior chest approach can improve sensation recovery in anterior chest , thus improving postoperative quality of life of patients .