甲状腺乳头状癌患者喉返神经旁淋巴结不同清扫方式对围术期指标及喉返神经的影响

Effects of Different Methods of Lymph Node Dissection near Recurrent Laryngeal Nerve on Perioperative Parameters and Recurrent Laryngeal Nerve in Patients with Thyroid Papillary Carcinoma

【目的】探讨甲状腺乳头状癌患者喉返神经旁淋巴结不同清扫方式对围术期指标及喉返神经的影响。【方法】选取2018年5月至2021年5月本院收治的98例甲状腺乳头状癌患者,根据清扫方式不同分为观察组(微创悬吊清扫术,n=52)和对照组(常规清扫术,n=46)。比较两组患者围术期指标(包括手术时间、术中出血量、胸管留置时间、住院时间和术后胸腔引流量),比较两组淋巴结清扫数目、淋巴结清扫成功率、喉返神经损伤发生率及并发症发生率。【结果】两组患者术中出血量、胸管留置时间、住院时间和术后胸腔引流量比较,差异无统计学意义(P>0.05)。观察组手术时间长于对照组,差异有统计学意义(P<0.05)。观察组患者淋巴结清扫数目和淋巴结清扫成功率均高于对照组,差异有统计学意义(P<0.05)。观察组、对照组喉返神经损伤发生率分别为15.38%(8/52)、13.04%(6/46),两组比较差异无统计学意义(χ^(2)=0.109,P=0.741)。观察组、对照组并发症总发生率分别为5.77%(3/52)、13.04%(6/46),差异无统计学意义(χ^(2)=1.549,P=0.213)。【结论】相比常规清扫术,微创悬吊清扫术用于甲状腺乳头状癌患者喉返神经旁淋巴结清扫,清扫成功率高,且不会明显增加手术出血量,是一种安全可靠的手术方法。

【Objective】To investigate the effect of different lymph node dissection methods near recurrent laryngeal nerve on perioperative parameters and Recurrent laryngeal nerve in patients with thyroid papillary carcinoma.【Methods】A total of 98 patients with papillary thyroid cancer admitted to our hospital from May 2018 to May 2021 were selected and divided into an observation group(minimally invasive suspension surgery,n=52)and a control group(conventional surgery,n=46)based on different cleaning methods.The perioperative indexes(including operation time,intraoperative blood loss,chest tube retention time,hospital stay and postoperative thoracic drainage volume)of the two groups were compared,and the number of lymph node dissection,the success rate of lymph node dissection,the incidence of recurrent laryngeal nerve injury and complications were compared between the two groups.【Results】There was no statistically significant difference between the two groups in terms of intraoperative bleeding volume,chest tube retention time,hospitalization time,and postoperative thoracic drainage volume.The surgical time in the observation group was longer than that in the control group,and the difference was statistically significant(P<0.05).The number of lymph node dissection and the success rate of lymph node dissection in the observation group were higher than those in the control group,and the difference was statistically significant(P<0.05).The incidence of recurrent laryngeal nerve injury in the observation group and the control group was 15.38%(8/52)and 13.04%(6/46)respectively,and there was no significant difference between the two groups(χ^(2)=0.109,P=0.741).The total incidence of complications in the observation group and the control group was 5.77%(3/52)and 13.04%(6/46),respectively,with no statistically significant difference(χ^(2)=1.549,P=0.213).【Conclusion】Compared with conventional dissection,minimally invasive suspension dissection is a safe and reliable surgical method for the removal of lymph nodes near the recurrent laryngeal nerve in patients with thyroid papillary carcinoma.