3D腔镜甲状腺癌根治术中喉上神经外支保护对患者呛咳及声音的影响

Effect of External Branch of Superior Laryngeal Nerve Protection for Choking Cough and Sound of Patients with 3D Endoscopic Radical Thyroidectomy for Thyroid Cancer

目的:探究3D腔镜甲状腺癌根治术中喉上神经外支(EBSLN)解剖观察和功能保护效果。方法:将2021年1月—2022年12月牡丹江市肿瘤医院收治的100例3D腔镜甲状腺癌根治术患者根据随机数字表法分为对照组50例(81侧)和观察组50例(80侧)。两组均进行3D腔镜甲状腺癌根治术治疗,对照组未进行EBSLN特殊解剖保护,观察组则进行EBSLN特殊保护。分析观察组的EBSLN Cernea分型占比、双侧解剖位置。比较两组的EBSLN损伤率、饮水呛咳情况(洼田饮水试验)及声音情况[嗓音障碍指数(VHI)]。结果:观察组中EBSLN Cernea分型Ⅰ型者30侧,占37.50%;Ⅱa型者36侧,占45.00%;Ⅱb型者12侧,占15.00%;Ni型者2侧,占2.50%;左侧与右侧喉上神经外支从甲状腺上动脉分出后至甲状腺上动脉进入甲状腺间的平均距离比较,差异无统计学意义(P>0.05)。观察组的EBSLN损伤率显著低于对照组,差异有统计学意义(P<0.05)。术前,两组的洼田饮水试验结果及VHI比较,差异均无统计学意义(P>0.05);术后,观察组的洼田饮水试验结果及VHI显著优于对照组,差异均有统计学意义(P<0.05)。结论:3D腔镜甲状腺癌根治术中EBSLN解剖观察和功能保护的效果较好,有助于控制EBSLN损伤率,对于术后呛咳及声音状态的不良影响相对更小。

Objective:To investigate the anatomical observation and functional protection effect of external branch of superior laryngeal nerve(EBSLN)during 3D endoscopic radical thyroidectomy for thyroid cancer.Method:A total of 100 patients with 3D endoscopic radical thyroidectomy for thyroid cancer admitted to Mudanjiang Tumor Hospital from January 2021 to December 2022 were divided into control group 50 cases(81 sides)and observation group 50 cases(80 sides)by random number table method.Both groups underwent 3D endoscopic thyroidectomy for thyroid cancer,the control group was not treated with special anatomical protection for EBSLN,the observation group was treated with special anatomical protection for EBSLN.The proportion of EBSLN Cernea types and bilateral anatomical position of observation group were analyzed.The EBSLN injury rates,coughing in drinking water condition(water swallow test)and sound condition[voice handicap index(VHI)]of two groups were compared.Result:In the observation group,30 sides were with EBSLN Cernea typeⅠ,the rate was 37.50%;36 cases were with typeⅡa,the rates was 45.00%;12 cases were with typeⅡb,the rates was 15.00%;2 cases were with type Ni,the rates was 2.50%;the average distance from the superior thyroid artery to the superior thyroid artery to enter the thyroid gland of external branch of the superior laryngeal nerve of left side and right side were compared,the difference was not statistically significant(P<0.05).The EBSLN injury rate in the observation group was significantly lower than that in the control group,the difference was statistically significant(P<0.05).Before the operation,the result of water swallow test and VHI of two groups were compared,the differences were not statistically significant(P>0.05);after the operation,the result of water swallow test and VHI of observation group were significantly better than those of control group,the differences were statistically significant(P<0.05).Conclusion:The effect of anatomical observation and functional protection of EBSLN during 3D endoscopic radical thyroidectomy for thyroid cancer is better,and it is helpful to the control of EBSLN injury rate,the adverse effects for postoperative cough and sound status are relatively smaller.