甲状腺癌根治术患者出现喉返神经损伤的相关因素分析

Analysis of related factors of recurrent laryngeal nerve injury in patients underwent radical operation for thyroid carcinoma

目的探讨甲状腺根治术后喉返神经损伤的预防方法。方法选取250例甲状腺癌根治术患者，首次手术患者193例，多次手术患者57例。分析损伤的主要原因、预防及失误处理方法。结果250例甲状腺肿瘤患者中，喉返神经总损伤率为5.6%（14/250）。由于操作过程欠熟练造成解剖层次不清发生喉返神经损伤6例（2.4%），助手配合失当2例（0.8%），出血引起视野不清4例（1.6%），慌乱止血造成损伤1例（0.4%），切口过小导致牵拉损伤1例（0.4%），差异有统计学意义（P〈0.05）。不同手术方式对喉返神经损伤的发生率也有影响，差异有统计学意义（P〈0.05），以甲状腺全切＋传统淋巴清扫术最高，喉返神经损伤率为13.0%。结论甲状腺肿瘤根治术中常见喉返神经损伤，选择正确手术方式，操作者熟练规范、配合默契有助于降低喉返神经损伤发生率。

Objective To investigate the effective methods of prevention of recurrent laryngeal nerve injury after thyroidectomy.MethodsA total of 250 patients with radical resection for thyroid carcinoma were selected, 193 cases underwent the operation for the first time, 57 patients with multiple surgeries. The main reason, injury prevention, and error processing method was analyzed.ResultsAmong the 250 patients with thyroid tumor, the total injury rate of recurrent laryngeal nerve was 5.6% （n=14）. The injury caused by the less skilled operation process of due to unclear anatomy occurrence of recurrent laryngeal nerve in 6 cases （2.4%）, 2 cases with improper assistant （0.8%）, hemorrhage resulting in unclear vision in 4 cases （1.6%）, panic bleeding injury in 1 case （0.4%）, small incision injury in 1 case （0.4%）, the differences were significant（P〈0.05）. The incidence of recurrent laryngeal nerve injury was also affected by different surgical methods, and the difference was significant（P〈0.05）. The rate of recurrent laryngeal nerve injury of total thyroidectomy and conventional lymph dissection was 13%, which was the highest.ConclusionsIn the radical operation of thyroid tumor, recurrent laryngeal nerve injury is common, the correct choice of surgical approach, the operator＇s proficiency in the specification and tacit understanding can help to reduce the incidence of recurrent laryngeal nerve injury.