96例腔鏡下甲狀腺腺葉切除術中解剖顯示喉返神經3種方法的臨床研究

Prospective study on three methods of dissecting recurrent laryngeal nerve in 96 cases of endoscopic thyroidectomy

目的探討和比較腔鏡下甲狀腺腺葉切除術中解剖顯露喉返神經3種不同方法的臨床優缺點。方法將96例腔鏡下甲狀腺腺葉切除的病例隨機分為3組:甲狀腺下動脈下方解剖顯露組(A組)、喉返神經入喉處解剖顯露組(B組)、甲狀腺囊外解剖顯露組(C組),對比分析3組的平均手術時間、手術中平均出血量及喉返神經損傷發生率。結果比較平均手術時間,A組優於B、C兩組,A組與B、C兩組有顯著性差異(P<0.05)。A、B、C 3組的手術中平均出血量及喉返神經損傷發生率經統計學處理三者相仿(P>0.05)。結論腔鏡下甲狀腺腺葉切除術的3種解剖顯露喉返神經方法,手術中出血量及喉返神經損傷發生率均無顯著性差異,但甲狀腺下動脈下方解剖顯露喉返神經的平均手術時間較短,是一較為實用的方法。

Objective To compare the clinical advantages and disadvantages of three different methods of dissecting recurrent laryngeal nerve in endoscopic thyroidectomy.Methods Ninety six cases of endoscopic thyroid lobectomy were divided into three groups:patients with anatomic exposal inferior to inferior thyroid artery(group A),patients with anatomic exposal at the position where recurrent laryngeal nerve(RLN)reached the throat(group B)and patients with anatomic exposal at extracapsular thyroid(group C).Average operation time,average amount of bleeding in operation and the incidence of RLN injury in three groups were compared.Results With respect to average operation time and in operation,group A was better than group B and group C;There is significant difference between group A and group B or C(P<0.05).Average amount of bleeding and the incidence of RLN injury in three groups were no significant difference(P>0.05).Conclusion The incidence of RLN injury and amount of bleeding among three methods of anatomic exposal of RLN in endoscopic thyroid lobectomy was no statistical significance.However,the anatomic exposal of RLN inferior to inferior thyroid artery featured shorter average operation time in operation;therefore,it was a relatively practical method.