甲状腺乳头状癌中央区淋巴结清扫术中显露喉返神经的临床意义

Clinical Significance of Intraoperative Revealing of RLN in Central Lymph Node Dissection for Papillary Thyroid Carcinoma

目的探讨甲状腺乳头状癌中央区淋巴结清扫术中显露喉返神经的临床意义。方法甲状腺乳头状癌患者78例根据随机抽签原则分为治疗组与对照组,各39例。所有患者都给予内镜甲状腺手术结合中央区淋巴结清扫术,其中治疗组术中显露喉返神经,而对照组术中不显露喉返神经。结果所有患者完成手术。2组在手术时间、术中出血量、切除甲状腺组织重量方面差异无统计学意义(P>0.05),但是治疗组的术后住院时间明显较少(P<0.05)。治疗组未发生喉返神经损伤;对照组出现喉返神经损伤的有4例,发生率为10.3%。治疗组的喉返神经损伤发生率明显低于对照组(P<0.05)。与对照组相比,治疗组术后24 h及48 h的疼痛都明显较低(P<0.05)。结论甲状腺乳头状癌中央区淋巴结清扫术中显露喉返神经不会增加手术难度,但可有效减少喉返神经损伤,缓解疼痛,值得临床推广应用。

Objective To investigate the clinical significance of intraoperative revealing of recurrent laryngeal nerve( RLN) in central lymph node dissection for papillary thyroid carcinoma. Methods 78 papillary thyroid cancer patients based on the principle of a random draw were equally divided into the treatment group and the control group,all patients were given endoscopic thyroid surgery combined with central lymph node dissection,and the treatment group revealed RLN during operation while the control group did not. Results All patients completed the surgery,the operative time,blood loss,weight of resected thyroid tissues between the 2 groups had no significant difference,but the postoperative hospital stay in the treatment group were significantly less than that of the control group( P < 0. 05). There were no recurrent laryngeal nerve injury occurred in the treatment group,while in the control group 4 cases had recurrent laryngeal nerve injury,incidence rate was 10. 3%,the incidence of recurrent laryngeal nerve injury in the treatment group were significantly lower than that of the control group( P < 0. 05). The postoperative 24 h and 48 h pain scores in the treatment group were significantly lower than that of the control group,there had statistically significant difference( P < 0. 05). Conclusion Intraoperative revealing of RLN in central lymph node dissection for papillary thyroid carcinoma do not increase surgical difficulty,but it can effectively reduce the incidence of recurrent laryngeal nerve injury and relieve pain,it is worthy of widely application.