喉上神经外支监测技术在甲状腺上极肿瘤手术中的应用

Application of monitoring technique of external branch of superior laryngeal nerve in operation of superior pole thyroid tumor

目的探讨喉上神经外支(EBSLN)监测技术在甲状腺肿瘤手术中的应用效果,确定喉上神经的解剖分型。方法前瞻性选取2018年11月至2020年11月收治的132例甲状腺肿瘤患者资料,按随机数字表法分为研究组(术中行EBSLN监测,n=66例)和对照组(术中不采用EBSLN监测,n=66例)。采用软件SPSS 19.0进行统计学分析。围手术期相关指标、术后嗓音障碍指数量表(VHI-10)评分等计量资料以(社s)表示,独立样本t检验;EBSLN损伤发生率等计数资料以[n(%)]表示,采用x检验。以P<0.05表示差异有统计学意义。结果研究组患者EBSLN损伤发生率、引流拔管时间及住院时间均明显低于对照组(P<0.05),术后第1天引流量均少于对照组(P<0.05);研究组患者术后1个月VIH-10评分均优于对照组(P<0.05)。研究组处理EBSLN113条,肉眼直视识别率低于术中EBSLN监测识别率(P<0.05);肿瘤位于上极时EBSLN肉眼识别率显著低于EBSLN监测识别率(P<0.05);EBSLN与甲状腺上动脉的交叉点距甲状腺上极>1 cm者共58条(51.3%),<1 cm者共55条(48.7%);依据EBSLN与咽下缩肌的关系分为:I型27条、I型51条、I型11条、IV型24条。结论EBSLN监测技术在甲状腺上极手术中可提高术中EBSLN的识别率,可对喉上神经外支的走行及变异进行定位,指导术中减少神经损伤发生的风险。

Objective To investigate the application of EBSLN monitoring technique in thyroid tumor surgery,and to determine the anatomical classification of the superior laryngeal nerve.Methods Data of 132 patients with thyroid tumor admitted from November 2018 to November 2020 were prospectively selected and randomly divided into study group(intraoperative EBSLN monitoring,n=66 cases)and control group(intraoperative EBSLN monitoring,n=66 cases).SPSS 19.0 was used for statistical analysis.Peri operative related indicators,postoperative voice disorder Index scale(VHI-10)score and other measurement data were represented by(x±s),independent t test;The incidence of EBSLN injury was expressed as[n(%)],and 2 test was used.P<O.05 indicated that the difference was statistically significant.Results The incidence of EBSLN injury,drainage extubation time and hospital stay in the study group were significantly lower than those in the control group(P<O.05),and the drainage volume on the first postoperative day was significantly lower than that in the control group(P<O.05).The VHI-10 score of the study group was better than that of the control group 1 month after surgery(P<O.05).In the study group,113 EBSLN cases were treated,and the visual recognition rate was lower than that of intraoperative EBSLN monitoring(P<O.05).The gross recognition rate of EBSLN was significantly lower than that of EBSLN monitoring when the tumor was located in the upper pole(P<O.05).The crossing point between EBSLN and superior thyroid artery was more than lcm away from the superior pole of thyroid in 58 cases(51.3%)and less than lcm in 55 cases(48.7%).According to the relationship between EBSLN and hypopharyngeal contractor,there were 27 cases of typeⅠ,51 cases of typeⅡ,11 cases of typeⅢand 24 cases of type N.Conclusion EBSLN monitoring technology can improve the intraoperative EBSLN recognition rate in the thyroid superior pole operation,and can locate the course and variation of the external branch of the superior laryngeal nerve,so as to guide the intraoperative reduction of the risk of nerve injury.