不同喉返神经保护方法在甲状腺癌术后复发再次手术中的效果

Effects of different recurrent laryngeal nerve protection methods in the reoperation for postoperative recurrence of thyroid cancer

目的观察不同喉返神经(RLN)保护方法在甲状腺癌术后复发再次手术中的效果。方法回顾性分析我院收治的68例甲状腺癌术后复发且需再次手术患者的临床资料。根据术中RLN保护方法将患者分为显露组(n=23,采用RLN常规显露)、IONM组n=25,采用术中神经监测(IONM)和CIONM组n=20,采用持续术中神经监测(CIONM)。比较3组患者围术期相关指标、术后并发症发生情况及声带功能指标。结果IONM组、CIONM组的手术时间、RLN确认时间、术中出血量及术后引流量短/少于显露组(P<0.05),住院费用高于显露组(P<0.05);3组患者术后住院时间比较,差异无统计学意义(P>0.05)。3组患者术后切口感染及甲状旁腺功能低下情况比较,差异无统计学意义(P>0.05);但3组患者术后RLN损伤情况比较,差异有统计学意义(P<0.05),且CIONM组术后RLN损伤率低于显露组(P<0.05)。术后1个月3组患者的基频、基频微扰及振幅微扰均较术前降低(P<0.05),且CIONM组低于显露组和IONM组(P<0.05)。结论在甲状腺癌术后复发再次手术中应用IONM及CIONM技术不仅可有效缩短RLN确认时间和手术时间,还可减少术中出血量和术后引流量,但在降低RLN损伤和声带功能恢复上CIONM技术优势更为明显,临床应用价值更高。

Objective To observe the effects of different recurrent laryngeal nerve(RLN)protection methods in the reoperation for postoperative recurrence of thyroid cancer.Methods The clinical data of 68 patients required reoperation for recurrence after thyroid cancer surgery in our hospital were retrospectively analyzed.The patients were divided into the exposure group(n=23,received conventional RLN exposure),the IONM group[n=25,received intraoperative neuromonitoring(IONM)]and the CIONM group[n=20,received continuous intraoperative neuromonitoring(CIONM)]according to different RLN protection methods.The perioperative related indexes,ocurrences of postoperative complications and vocal cord function indexes in the three groups were compared.Results The operation time,RLN confirmation time,intraoperative blood loss and postoperative drainage volume of the IONM group and the CIONM group were significantly shorter/less than those of the exposure group(P<0.05),and the hospitalization cost was significantly higher than that of the exposure group(P<0.05);there was no statistically significant difference in the postoperative hospital stay among the three groups(P>0.05).There was no statistically significant difference in the postoperative incision infection or hypoparathyriodism among the three groups(P>0.05);while there was statistically significant difference in the RLN injury among the three groups(P<0.05),and the postoperative RLN injury rate of the CIONM group was lower than that of the exposure group(P<0.05).The fundamental frequency,fundamental frequency perturbation and amplitude perturbation 1 month after operation in the three groups were lower than those before operation(P<0.05),and those in the CIONM group were lower than those in the exposure group and the IONM group(P<0.05).Conclusion The application of IONM and CIONM technologies in the reoperation for postopreative recurrence of thyroid cancer can not only effectively shorten the RLN confirmation time and operation time,but also reduce the intraoperative blood loss and postoperative drainage volume,while CIONM technology has more obvious advantages in reducing the RLN injury and recovering the vocal cord function,with higher clinical application value.