入喉处解剖暴露喉返神经在甲状腺腺叶切除术中的应用价值及安全性研究

Application Value and Safety of Dissecting and Exposing the Recurrent Laryngeal Nerve at the Entrance To the Larynx in Thyroid Lobectomy

目的 探讨入喉处暴露喉返神经对甲状腺叶切除术中的应用效果。方法 挑选94例行甲状腺叶切除术者,依照随机数字表法分为对照组和试验组,各47例。对照组选取甲状腺动脉下方暴露,试验组使用入喉处解剖暴露喉返神经。对比2组围术期指标、甲状腺功能[甲状腺素(T4)、游离甲状腺素(FT4)、甲状旁腺素(PTH)]、声带功能[基频、谐波造成比(HNR)、标准化噪声能量(NNE)]、并发症发生率变化。结果 与对照组比较,试验组操作时间、住院天数短,且术中出血少,术后1d疼痛评分低(P<0.05);与对照组比较,术后3d试验组FT4、PTH、T4水平较高(P<0.05);与对照组比较,术后1个月试验组基频、NNE较低,且HNR较高(P<0.05);试验组并发症发生率8.51%(4/47)较对照组25.53%(12/47)低(P<0.05)。结论 入喉处暴露喉返神经对甲状腺叶切除术中疗效显著,可以改善围术期指标,改善甲状腺功能和声带功能,且其能降低并发症发生率,值得临床进一步推广应用。

Objective To investigate the applicationeffect of exposing recurrent laryngeal nerve at the laryngeal entrance in thyroid lobectomy.Methods A total of 94 case patientswho underwent thyroidlobectomy were selected and divided into a control group and an experimental group according to the random number table method,with 47 cases in each group.The control group was exposed below the thyroid artery,while the experimental group exposed the recurrent laryngeal nerve at the laryngeal entrance.The changes of perioperative indexes,thyroid function[thyroxine(T4),free thyroxine(FT4),parathyroid hor-mone(PTH)],vocal cord function[fundamental frequency,harmonic generation ratio(HNR),normalized noise energy(NNE)],and the incidence of complications of the two groupswere compared.Results Compared with the control group,the operation time and hospitalization time of the experimental group were shorter,the amount of intraoperative blood loss was less,and the pain score on the first day after operationwas lower(P<0.05);Compared with the control group,the levels of FT4,PTH and T4 in the experimental group3 days after operation were higher(P<0.05);Compared with the control group,the fundamental frequen-cy and NNE of the experimental group one month after operation were lower,and the HNR was higher(P<0.05);The compli-cation rate of the the experimental group 8.51%(4/47)was lower than that of the control group 25.53%(12/47)(P<0.05).Conclusion Anatomical exposure of the recurrent laryngeal nerve into the larynx has a significant effect in thyroid lobecto-my,which can improve the perioperative indicators,improve the thyroid function and vocal cord function,and can reduce the incidence of complicatios.It is worthy of further clinical application.