甲状腺癌手术导致喉返神经损伤的临床分析

Analysis for the related reasons and relevant prevention measures of recurrent laryneal nerve damage caused by thyroid carcinoma surgery

目的研究甲状腺癌手术导致的喉返神经损伤的相关原因及相关防治措施。方法选取2012年4月至2016年2月接受甲状腺癌手术患者80例,分别收集患者手术方式、手术部位以及神经显露情况,并将其与喉返神经损伤发生率进行研究,作多因素Logistic回归分析。结果左侧手术患者喉返神经损伤发生率为0(0/37),显著低于右侧手术患者的11.63%(5/43);首次手术患者喉返神经损伤发生率为1.72%(1/58),显著低于再次手术患者的18.18%(4/22);神经暴露患者的喉返神经损伤发生率为0(0/49),显著低于神经不暴露患者的16.13%(5/31),差异均有统计学意义(均P<0.05)。经多因素Logistic回归分析发现:右侧手术、再次手术、神经不暴露均是影响患者喉返神经损伤的独立危险因素。结论手术中应尽量采用左侧手术,充分暴露喉返神经,以降低喉返神经损伤的发生率。

Objective To investigate the the related reasons and relevant prevention measures of recurrent laryneal nerve damage caused by thyroid carcinoma surgery.Methods A total of 80 patients with thyroid carcinoma who underwent surgical treatment in our hospital from April 2011 to February 2016 were enrolled in the study. The data of surgery mode,surgical site and nerve exposure status were collected,moreover, the incidence of recurrent laryngeal nerve injury was observed and analyzed by means of multivariate logistic regression analysis.Results The incidence rate of recurrent laryneal nerve damage on the left side of surgery was 0(0/37),which was significantly lower than that on the right side of surgery (11.63%(5/43))The incidence rate of recurrent laryneal nerve damage in the patients with the first surgery was 1.72%(1/58),which was significantly lower than that [18.18%(4/22)] of the patients with the second surgery(P<0.05). The incidence rate of recurrent laryneal nerve damage in patients with nerve exposure was 0(0/49),which was significantly lower than that [16.13%(5/31)] of the patients without nerve exposure(P<0.05). The multiariable Logistic regression analysis showed that the right side of the surgery,reoperation, without nerve exposure were the independent risk factors affecting recurrent laryneal nerve damage of patients.Conclusion It necessary to perform the surgery on the left side as much as possible, to fully expose laryngeal recurrent nerve in order to reduce the incidence of recurrent laryneal nerve damage.