不同手术入路显露甲状腺喉上神经对比研究

Comparative study of different operative approachs for the treatment of upper thyroid gland

目的探讨处理甲状腺上极时选择不同手术入路显露喉上神经疗效。方法回顾性分析2016年1月至2018年12月间蚌埠医学院第一附属医院肿瘤外科收治的须行腺叶切除的87例病人的临床资料,经术前超声评估肿瘤位于甲状腺上极或甲状腺腺体肥大,根据手术入路分为环甲肌入路(Cricothyroid approach)42例和胸骨舌骨肌-胸骨甲状肌间隙入路(带状肌间入路,viacervical strap muscles approach)45例,比较术中喉上神经显露情况及术后喉上神经功能及甲状腺旁腺的相关并发症。结果与环甲肌入路组喉上神经找出率(83.3%)相比,经胸骨甲状肌-胸骨舌骨肌入路组喉上神经找出率高(95.6%)(P<0.05),环甲肌入路组喉上神经寻找所用时间(5.75±0.24)min,经胸骨甲状肌-胸骨舌骨肌入路组较短(3.83±0.37)min(P<0.05),术后随访手术病人,对比饮水咳呛、发音低沉、手足麻木等症状,手足麻木症状两组差异无统计学意义(P>0.05),经胸骨甲状肌-胸骨舌骨肌入路组术后饮水咳呛、发音低沉并发症少于经环甲肌入路组(P<0.05)。结论经胸骨舌骨肌-胸骨甲状肌间隙入路对比应用环甲肌入路,喉上神经找出率高、寻找时间短,在上极的甲状腺肿瘤及腺体肥大的情况下应用此入路有助于暴露上极并保护喉上神经外支。

Objective To explore the feasibility of different operative approaches for the treatment of upper thyroid gland.Methods The clinical data of 87 patients underwent lobectomy in Department of Oncological Surgery,the First Affiliated Hospital of Bengbu Medical College from January 2016 to December 2018 were analyzed retrospectively.Preoperative ultrasound was used to evaluate the location of the tumor in the upper thyroid gland or thyroid gland hypertrophy.According to the operative approach,87 cases were divided into two groups including 42 cases of the cricothyroid approach and 45 cases of viacervical strap muscles approach.The intraoperative exposure of superior laryngeal nerve and postoperative complications of superior laryngeal nerve function and parathyroid gland were compared.Results Compared with the superior laryngeal nerve finding rate(83.3%)in the cricothyroid approach,the superior laryngeal nerve finding rate was higher(95.6%)(P<0.05)in the viacervical strap muscles approach.The searching time of superior laryngeal nerve was(5.75±0.24)min in the cricothyroid approach group,through viacervical strap muscles approach group was(3.83±0.37)min(P<0.05).In the group of viacervical strap muscles approach,the incidence of cough and low pronunciation was less than that in the group of cricothyroid approach(P<0.05).There was no difference between the two groups in the symptoms of numbness of hand and foot(P >0.05).Conclusion The viacervical strap muscles approach compares the cricothyroid approach to the laryngeal nerve with a high rate of finding and a short searching time.Applying viacervical strap muscles approach in the case of an upper thyroid tumor and glandular hypertrophy helps to expose the upper pole and protect the external nerve branch of the larynx.