喉返神经显露在甲状腺切除术中的临床意义

Clinical significance of recurrent laryngeal nerve exposure in thyroidectomy

目的探讨显露与不显露喉返神经在甲状腺手术中的损伤情况,并寻找更加安全的手术方法避免神经损伤。方法收集我院2013年12月至2016年12月行甲状腺双叶次全切除、近全切除或全切除患者的临床资料共298例,其中术中显露喉返神经者(显露组)170例、不显露喉返神经者(非显露组)128例,分析2组喉返神经损伤率,并分析发生喉返神经损伤的原因,总结预防术中损伤喉返神经的方法。结果术中显露喉返神经组损伤率为5.3%,术中未显露喉返神经组损伤率5.5%,两者比较差异无统计学意义(P>0.05);术中显露喉返神经组中有30例甲状腺癌,均行甲状腺癌根治术,甲状腺癌根治率100%,术中未显露喉返神经组中有24例甲状腺癌,其中6例行淋巴结清扫,18例未行淋巴结清扫,甲状腺癌根治率25%,两者比较差异有统计学意义(P<0.05)。结论术中显露喉返神经并未增加喉返神经的损伤率。显露喉返神经有利于直视下保护喉返神经,使甲状腺癌的切除范围更彻底,保证了甲状腺癌的根治性。

Objective To investigate the injury of recurrent laryngeal nerve in thyroid surgery and to find a safer surgical method to avoid nerve injury. Methods The clinical data of 298 cases of Sub-total resection Near total resection or total resection of thyroid gland from December 2013 to December 2016 were collected,of which 170 cases of recurrent laryngeal nerve(exposure group) were revealed and 128 cases of recurrent laryngeal nerve(non-exposure group) were not revealed. The incidence of recurrent laryngeal nerve injury in two groups was analyzed,and the causes of recurrent laryngeal nerve injury were analyzed. Results The injury rate of patients with recurrent laryngeal nerve was 5.3% during the operation and 5.5% during the operation. There was no statistical difference between the two(P>0.05);During the operation,there were 30 cases of thyroid cancer in the recurrent laryngeal nerve group,all of which underwent radical surgery for thyroid cancer. The radical rate of thyroid cancer was 100%. During the operation,24 cases of thyroid cancer in the recurrent laryngeal nerve group were not revealed,of which 6 were Lymphatic node clearance and 18 were unperformed lymph node clearance,thyroid cancer radical rate of 25%,The difference between the two is statistically significant(P<0.05). Conclusion The exposure of recurrent laryngeal nerve did not increase the injury rate of recurrent laryngeal nerve. The exposure of recurrent laryngeal nerve is conducive to the protection of recurrent laryngeal nerve under direct viewing,so that the scope of thyroid cancer resection is more complete,ensuring the root cure of thyroid cancer.