肌间入路联合神经监测技术对甲状腺癌手术中喉上神经的保护

Application of paraspinal approach and intraperative neuromonitoring in surperior laryngeal nerve protection during thyroidectomy

目的探讨肌间入路(paraspinal approach)法联合神经监测技术(intraperative neuromonitoring,INM)在甲状腺手术中保护喉上神经(surperior laryngeal nerve,SLN)的应用价值。方法将符合条件的连云港市第二人民医院甲乳外科2017年6月至2018年2月收治的甲状腺癌(thyroid cancer)患者214例,根据随机数字表法分为2组,对照组(n=129例)采用常规颈白线入路手术,观察组(n=85例)在对照组基础上采取肌间入路联合INM,比较两组的手术时间、术中出血量及有无SLN损伤等。结果所有患者均成功完成手术,对照组和观察组术中出血量分别为(16.64±4.10)ml和(16.58±3.90)ml(t=0.086,P=0.931);手术时间分别为(74.52±17.94)min和(72.06±15.31)min(t=0.792,P=0.430);两组间比较差异均无统计学意义。在SLN显露方面,对照组(134/180)明显低于观察组(98/110),差异有统计学意义(Z=-3.02,P=0.003);术后对照组出现暂时性SLN损伤6例,观察组未出现SLN损伤,两组间比较差异有统计学意义(Z=-2.012,P=0.044)。结论肌间入路联合INM对SLN的保护具有重要意义,可提高甲状腺癌手术的安全性和时效性。

Objective To investigate the value of paraspinal approach and intraperative neuromonitoring in surperior laryngeal nerve(SLN)protection during thyroidectomy.Methods 214 cases of thyroid cancer admitted in our hospital from Jun.2017 to Feb.2018 were randomly divided into 2 groups.Patients in control group used the neck white line approach,while patients in observation group used paraspinal approach and intraperative neuromonitoring on the basis of the control group.Operation time,blood loss and SLN injury were compared between the two groups.Results Operations were successfully performed in 214 cases.The amount of blood loss was(16.64±4.10)ml in the control group and(16.58±3.90)ml in the observation group(t=0.086,P=0.931).The operation time was(74.52±17.94)and(72.06±15.31)min(t=0.792,P=0.430).There was no significant difference in intraoperative blood loss or operation time between the two groups(P>0.05).SLN was seen in 134(74.44%)of 180 nerves and 98(89.09%)of 110 nerves,showing significant differences between the two groups(Z=-3.02,P=0.003).Temporary SLN injury occurred to 6 cases(4.65%)in the control group after operation,while it didn’t occurred to any one in the observation group(Z=-2.012,P=0.044).Conclusion Application of paraspinal approach and intraperative neuromonitoring can improve the efficiency and safety of thyroidectomy,and is significant for SLN protection during thyroidectomy.