“RLN三角”在经腋窝入路腔镜甲状腺切除术中的应用研究

Application of"RLN triangle"in endoscopic thyroidectomy through axillary approach

目的探究在经腋窝入路腔镜甲状腺切除术中建立“RLN三角”对RLN的显露效果。方法回顾性分析2021年12月至2022年10月收治的91例甲状腺癌患者资料,均行腋窝入路腔镜甲状腺切除术治疗,术中根据RLN显露途径不同分为两组,观察组(n=48例)采用最下途径法在颈总动脉内侧壁下段建立的“RLN三角”区显露RLN,对照组(n=43例)采用传统上路途径法在甲状软骨下角下方1.0 cm入喉处显露RLN。采用SPSS 24.0统计软件分析数据,计数资料用[例(%)]表示,组间比较行χ^(2)检验;围手术期指标、嗓音功能和吞咽功能指标等计量资料用(x±s)表示,组间比较行独立样本t检验。P<0.05为差异有统计学意义。结果观察组患者手术时间、RLN显露时间、术中出血量、术后引流量等指标均优于对照组(P<0.05);观察组患者术后3 d的嗓音障碍指数、吞咽障碍指数显著低于对照组(P<0.05);两组术后6个月的嗓音障碍指数、吞咽障碍指数比较,差异无统计学意义(P>0.05);两组患者手术并发症总发生率比较,差异无统计学意义(P>0.05)。结论在腋窝入路腔镜甲状腺切除术中采用最下途径法可明显缩短RLN显露时间和手术时间,术中出血量更少,术后嗓音及吞咽功能障碍程度更轻,更利于RLN保护。

Objective To explore the effect of establishing"RLN triangle"on RLN exposure in transaxillary approach endoscopic thyroidectomy.Methods Data of 91 patients with thyroid cancer admitted from December 2021 to October 2022 were retrospectively analyzed,all of whom were treated with axillary approach endoscopic thyroidectomy.The patients were divided into two groups according to different RLN exposure pathways.The observation group(n=48 cases)was exposed in the"RLN triangle"area established in the lower section of the medial wall of the common carotid artery by the lowest approach method.In the control group(n=43 cases),RLN was exposed in the larynx 1.0 cm below the inferior Angle of thyroid cartilage by traditional road approach.SPSS 24.0 statistical software was used to analyze the data.The counting data were represented by[cases(%)],and the comparison between groups was conducted byχ^(2)test.Measurements of perioperative indexes,voice function and swallowing function were expressed as(x±s),and independent sample t test was performed for inter-group comparison.P<0.05 was statistically significant.Results The indexes of operation time,RLN exposure time,intraoperative blood loss and postoperative drainage volume in observation group were better than those in control group(P<0.05).The voice disturbance index and swallowing disturbance index in the observation group were significantly lower than those in the control group(P<0.05).There was no significant difference in voice disorder index and swallowing disorder index between the two groups 6 months after operation(P>0.05).There was no significant difference in the total incidence of surgical complications between the two groups(P>0.05).Conclusion The use of the lowest approach method in axillary endoscopic thyroidectomy can significantly shorten the exposure time and surgical time of RLN,reduce intraoperative bleeding,and alleviate postoperative vocal and swallowing dysfunction,which is more conducive to RLN protection.