喉返神经导向内侧入路在分化型甲状腺癌根治术中的应用价值

Application of recurrent laryngeal nerve guided medial approach in radical thyroid cancer surgery

目的:探讨喉返神经导向内侧入路在分化型甲状腺癌(DTC)根治术中的应用价值。方法:回顾性分析广州中医药大学第二附属医院(广东省中医院)甲状腺外科2020年1月至12月收治的甲状腺全切+颈部Ⅵ区淋巴结清扫术的DTC患者。根据术中手术入路方式对纳入患者进行分组。观察组术中采用喉返神经导向内侧入路,对照组术中采用传统手术入路。比较两组患者住院时间、手术中出血量、手术时间,比较术前及术后24 h、1个月血钙(Ca^(2+))及甲状旁腺激素(PTH)水平,比较术后前3天引流量,比较两组喉返神经损伤和甲状旁腺误切发生率。结果:226例DTC患者中,观察组119例,对照组107例。两组患者性别、年龄、病程、BMI、肿瘤直径等一般资料比较差异均无统计学意义(P>0.05)。两组患者手术时间、住院时间比较差异无统计学意义(P>0.05)。观察组术中出血量少于对照组(P<0.05)。观察组术后24 h的Ca^(2+)和PTH水平均高于对照组(P<0.05);术后1个月,观察组PTH水平仍高于对照组(P<0.05)。观察组术后第1天、第2天、第3天引流量均少于对照组(P<0.05)。观察组术后喉返神经损伤发生率及甲状旁腺误切率低于对照组(P<0.05)。结论:采用喉返神经导向内侧入路行DTC根治术能较好地保护喉返神经及甲状旁腺功能。

Objective:To explore the clinical effect of the medial approach of the recurrent laryngeal nerve in the radical operation of differentiated thyroid cancer.Methods:Retrospective analysis of DTC patients admitted to the Department of Vascular and Thyroid Surgery of Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2020 to December 2020 who received total thyroidectomy+neck dissection of lymph nodes in zoneⅥ.Group the included patients according to different surgical approaches during the operation.The observation group used the recurrent laryngeal nerve to guide the medial approach during the operation,and the control group used the traditional surgical approach during the operation.The data of hospitalization time,blood loss during operation,operation time,preoperative and postoperative 24 hours,and 1 month postoperative blood calcium and parathyroid hormone data were compared between the two groups of study subjects.At the same time,the data of drainage,recurrent laryngeal nerve injury and parathyroid miscutting in the first 3 days after surgery were statistically compared.Results:A total of 226 DTC patients were collected in this study.The observation group and the control group were 119 and 107respectively.There were no statistically significant differences in general informaion such as gender,age,course of disease,BMI,tumor diameter between the two groups(P>0.05).There was no significant difference in the operation and hospitalization time between the two groups(P>0.05).Patients in the observation group had less intraoperative blood loss than the control group(P<0.05).Comparing the levels of Ca^(2+)and PTH at 24 h after operation,patients in the observation group was higher than the control group(P<0.05).Comparing the level of Ca^(2+)and PTH at 1 month after operation,patients in the observation group was still higher than the control group,but only the PTH level comparison was statistically different(P<0.05).Comparison of total drainage on the first day,second day,and 3 days after operation,the observation group was less than the control group(P<0.05).The incidence of postoperative recurrent laryngeal nerve injury and miscutting of parathyroid glands in the observation group were lower than those in the control group(P<0.05).Conclusion:DTC radical resection with medial approach guided by the recurrent laryngeal nerve can better protect the function of the recurrent laryngeal nerve and parathyroid glands.