甲状腺癌切除术中甲状腺背侧支血管定位喉返神经的临床效果

Analysis of the effect of locating the recurrent laryngeal nerve with dorsal thyroid vessels in thyroid carcinoma resection

目的分析甲状腺癌切除术中采用甲状腺背侧支血管定位喉返神经的临床应用效果。方法采用便利抽样法收集2018年10月至2022年3月中国人民解放军联勤保障部队第九○一医院收治的86例拟行甲状腺切除术治疗的甲状腺癌患者,根据不同喉返神经定位方式将患者分为研究组43例、对照组43例,两组患者均行甲状腺切除术,术中研究组采用甲状腺背侧支血管对患者喉返神经进行定位,对照组通过充分暴露患者甲状腺背侧面寻找喉返神经,分析研究组患者喉返神经与甲状腺背侧支定位血管的位置关系;比较两组患者手术切除范围、手术时间、术中出血量及喉返神经损伤情况。结果43例研究组患者均顺利找到甲状腺背侧支定位血管,血管直径(2.46±0.25)mm,与甲状腺软骨下角距离为(1.28±0.37)cm,以静脉形式出现者占18.60%、认动脉形式出现者占81.40%,喉返神经位于甲状腺背侧支定位血管深面者占90.70%、位于甲状腺背侧支定位血管浅面者占9.30%,喉返神经与甲状腺背侧支定位血管呈垂直关系者占93.02%、呈平行关系者占6.98%。研究组患者手术时间明显短于对照组[(99.82±13.41)min vs.(108.96±14.57)min]、术中出血量明显少于对照组[(35.34±5.79)ml vs.(46.27±6.44)ml]、喉返神经损伤率明显低于对照组(0 vs.9.3%),差异有统计学意义(P<0.05)。结论在甲状腺切除术应用甲状腺背侧支血管对喉返神经进行定位,可有效缩短手术时间,减少术中出血量,降低喉返神经损伤的发生风险。

Objective To analyze the clinical effect of locating the recurrent laryngeal nerve with the dorsal branch of thyroid in thyroid carcinoma resection.Methods Uses the convenience sampling method to collect in October 2018 to March 2022,86 cases from the 901st Hospital of PLA Joint Logistic Support Force of thyroid gland resection treatment of patients with thyroid cancer,according to the different laryngeal recurrent nerve localization,patients can be divided into research group 43 cases,control group 43 cases,two groups of patients with thyroid gland resection.During the operation,the recurrent laryngeal nerve was located by the dorsal branch of thyroid in the study group,while the recurrent laryngeal nerve was found by fully exposing the dorsal side of thyroid in the control group.The position relationship between the recurrent laryngeal nerve and the dorsal branch of thyroid in the study group was statistically analyzed.Surgical resection scope,operation time,intraoperative blood loss and recurrent laryngeal nerve injury were compared and observed between the two groups.Results All the 43 patients in the study group successfully found the located vessels of dorsal branch of thyroid,the diameter of the vessels was(2.46±0.25)mm,and the distance from the inferior angle of thyroid cartilage was(1.28±0.37)cm.18.60%of the patients appeared in the form of vein and 81.40%in the form of artery.90.70%of the patients had recurrent laryngeal nerve located on the deep surface of the vessels located on the dorsal branch of thyroid gland,9.30%on the superficial surface of the vessels located on the dorsal branch of thyroid gland,93.02%of the patients had a vertical relationship with the vessels located on the dorsal branch of thyroid gland,and 6.98%had a parallel relationship.The operation time of patients in the study group was significantly shorter than that of the control group[(99.82±13.41)min vs.(108.96±14.57)min],and the amount of intraoperative blood loss was significantly less than that of the control group[(35.34±5.79)ml vs.(46.27±6.44)ml],the injury rate of recurrent laryngeal nerve was significantly lower than that of control group(0 vs.9.3%).Conclusions Locating the recurrent laryngeal nerve with dorsal branch thyroid vessels during thyroidectomy can effectively shorten the operation time,reduce the amount of blood loss during the operation and reduce the risk of recurrent laryngeal nerve.