免充气经腋窝入路全腔镜下甲状腺手术对喉返神经功能的影响

Impact of total endoscopic thyroid surgery via air-free transaxillary approach on function of recurrent laryngeal nerve

目的探讨免充气经腋窝入路全腔镜下甲状腺手术对喉返神经(recurrent laryngeal nerve,RLN)功能的影响。方法选取符合纳入和排除标准的患者300例,根据手术方案不同分为腔镜组与开放组,每组150例。腔镜组患者行免充气经腋窝入路全腔镜下甲状腺手术治疗,开放组行经颈前切开开放手术治疗。比较2组患者的手术情况及术后恢复情况。Cox比例风险回归模型分析甲状腺手术中发生RLN损伤的影响因素。结果与开放组相比,腔镜组手术时间延长,术中出血量减少,术后引流液总量增加,术后住院时间缩短;术后24、48 h,腔镜组患者VAS评分均较低,切口美容满意度评分均较高;术后1周腔镜组患者的声带病变(χ^(2)=15.153,P <0.001)、嗓音障碍和吞咽功能障碍的发生率(χ^(2)=12.837,P <0.001)均较低,差异均具有统计学意义(P <0.05)。行免充气经腋窝入路全腔镜下甲状腺手术和恶性肿瘤是甲状腺手术中发生RLN损伤的独立危险因素(P <0.05)。结论免充气经腋窝入路全腔镜下甲状腺手术可有效提高患者术后生活质量,值得临床推广使用。

Objective To explore the impact of total endoscopic thyroid surgery via air-free transaxillary approach on function of recurrent laryngeal nerve(RLN).Methods A total of 300 patients met the criteria for inclusion and exclusion were divided into endoscopy group(n=150)and open group(n=150).The patients in the endoscopy group were treated with total endoscopic thyroidectomy via air-free transaxillary approach,while those in the open group received open surgery through anterior cervical incision.The surgical situation and postoperative recovery in the two groups were compared.Cox proportional hazard regression model was used to analyze the influencing factors of occurring intraoperative RLN injury.Results As compared with the open group,the endoscopy group had longer surgical duration,less intraoperative blood loss,more postoperative drainage and shorter postoperative hospital stay,and it had lower VAS score and higher satisfaction score on the cosmetic incision 24 and 48hours after operation.One week after operation,the incidences of vocal cord lesions(χ^(2)=15.153,P<0.001),dysphonia and dysphagia(χ^(2)=12.837,P<0.001)in the endoscope group were significantly lower than those in the control group(P<0.05).Total endoscopic thyroid surgery via air-free transaxillary approach and malignant tumors were the key risk factors for intraoperative RLN injury.Conclusion sTotal endoscopic thyroid surgery via air-free transaxillary approach can effectively improve the postoperative quality of life in patients and is worthy of clinical application.