“最下途径法”解剖喉返神经在手术治疗甲状腺癌患者中的应用效果分析

The Application Effect of"The Lowest Approach"to Dissect Recurrent Laryngeal Nerve in the Surgical Treatment of Patients with Thyroid Cancer

目的探讨“最下途径法”解剖喉返神经在甲状腺癌手术中的应用效果。方法选取2018年4月至2019年9月禹州市中心医院收治的82例甲状腺癌患者为研究病例,通过随机抽签方式将其分为对照组与试验组,各41例。对照组行常规根治术,试验组在常规根治术中应用“最下途径法”寻找、解剖喉返神经。比较两组手术相关指标、喉返神经损伤情况和血清Ca^(2+)水平。结果试验组术中喉返神经电生理信号振幅下降>50%的发生率小于对照组,淋巴结清扫数量大于对照组,差异有统计学意义(P<0.05)。试验组喉返神经永久性损伤的发生率小于对照组,差异有统计学意义(P<0.05);两组喉返神经短暂性损伤的发生率差异无统计学意义(P>0.05)。术前两组血清Ca^(2+)水平比较,差异无统计学意义(P>0.05);术后第5 d试验组的血清Ca^(2+)水平大于对照组,差异有统计学意义(P<0.05)。结论“最下途径法”寻找、解剖喉返神经可减轻甲状腺癌常规根治术对喉返神经的损伤,有利于清扫淋巴结,降低血清Ca^(2+)水平的下降程度。

Objective To investigate the application effect of"the lowest approach"to dissect recurrent laryngeal nerve(RLN)in thyroid cancer surgery.Methods A total of 82 patients with thyroid cancer admitted to Yuzhou Central Hospital from April 2018 to September 2019 were selected as the study cases.They were divided into control group and experimental group by random lottery method,with 41 cases in each group.The control group underwent conventional radical surgery,and the experimental group used the"lowest approach method"to find and dissect the recurrent laryngeal nerve during the conventional radical surgery.The operation related indicators,recurrent laryngeal nerve injury and serum Ca^(2+)level were compared between the two groups.Results The incidence of intraoperative recurrent laryngeal nerve electrophysiological signal amplitude decrease>50%in the experimental group was less than that in the control group,and the number of lymph node dissection was more than that in the control group,the difference was statistically significant(P<0.05).The incidence of permanent recurrent laryngeal nerve injury in the experimental group was lower than that in the control group,and the difference was statistically significant(P<0.05);There was no significant difference in the incidence of transient recurrent laryngeal nerve injury between the two groups(P>0.05).There was no significant difference in serum Ca^(2+)level between the two groups before operation(P>0.05);The serum Ca^(2+)level of the experimental group was higher than that of the control group at the 5th day after operation,and the difference was statistically significant(P<0.05).Conclusion“the lowest approach"to find and dissect recurrent laryngeal nerve can reduce the injury of recurrent laryngeal nerve in routine radical resection of thyroid cancer,which is beneficial to lymph node dissection and reduce the decrease of serum Ca^(2+)level.