分化型甲状腺癌喉返神经入喉处受侵特点及外科处理

Characteristics and surgical treatment for differentiated thyroid carcinoma with recurrent laryngeal nerve involvement at the entrance of larynx

目的探讨甲状腺癌喉返神经(recurrent laryngeal nerve,RLN)入喉处受侵的临床特点及外科处理方法。方法回顾性分析沧州市中心医院2012年8月至2018年8月甲状腺癌侵犯RLN的30例患者的临床资料,根据RLN受侵部位不同分为两组,其中14例入喉处受侵为A组,其他部位受侵16例为B组。对两组的手术学指标、术后并发症和短期疗效进行对比分析。结果A组与B组相比手术时间、出血量、多发病灶比率、粘连浸润差异均无统计学意义(均P>0.05)。术后情况比较:A组较B组肿瘤小(t=-3.614,P=0.001),淋巴结转移率低(χ^(2)=5.593,P=0.018),微小癌比率高(χ^(2)=4.051,P=0.044)。而术后1、6、12、24个月声音嘶哑及喉镜声带异常发生率及术后6、12、24个月肿瘤复发率差异均无统计学意义(均P>0.05)。结论甲状腺癌RLN入喉处受侵,肿瘤直径相对较小,微小癌比率高,淋巴结转移率较低。

Objecfive To investigate the clinical characteristics and surgical management of tumor invasion on recurrent laryngeal nerve at the entrance of larynx in thyroid cancer.Methods The clinical data of 30 patients with recurrent laryngeal nerve invasion by thyroid cancer from Aug 2012 to Aug 2018 in Cangzhou Central Hospital were analyzed retrospectively.Patients were divided into groups A(14 cases,nerve was invaded at the larynx)and group B(16 cases,nerve was involved in other parts).Results Between the two groups,operation time,intraoperative blood loss,number of tumor focus,adhesion and infiltration were not statistically different(P>0.05).The tumor size in group A was smaller(t=-3.614,P=0.001),the lymph node metastasis rate was lower(χ^(2)=5.593,P=0.018),and the microcancer rate was higher(χ^(2)=4.051,P=0.044).Follow up data up to 24 months showed there were no significant difference in postoperative hoarseness,laryngoscope abnormality and recurrence rate between the two groups(all P>0.05).Conclusion Patients of thyroid cancer with recurrent laryngeal nerve invasion at the larynx had relatively small tumor size,higher proportion of microcancer,lower rate of lymph node metastasiss.