甲状腺手术中显露喉返神经对预防喉返神经损伤的临床研究  

Clinical Study on Exposure of Recurrent Laryngeal Nerve in the Operation of Thyroid Gland in Preventing Recurrent Laryngeal Nerve Injury

作　　者：郭晓明[1] 张晓征[1] 徐涵[1] 王燕鹏[1] 桑畅野 

机构地区：[1]北京市延庆区医院/北京大学第三医院延庆医院普外科,北京102100

出　　处：《中国继续医学教育》2016年第35期72-74,共3页China Continuing Medical Education

摘　　要：目的 对在行甲状腺手术时解剖并显露出喉返神经以减少其损伤的临床效果与意义进行探究。方法 回顾性分析我院2010年3月-2015年3月收治的196例甲状腺手术患者,按是否显露喉返神经分成观察组89例、对照组107例。观察组患者术中解剖,显露喉返神经,对照组采用常规手术,不显露喉返神经。比较两组患者术后对喉返神经造成的损伤情况。结果 观察组中有3例患者在术后损伤了喉返神经,所占比例为3.37%,且均属暂时性的损伤,未发生永久性损伤情况;对照组中有12例患者损伤了喉返神经,所占比例是11.22%,其中10例属暂时性的损伤、2例属永久性的损伤,与对照组相比,观察组在术后出现神经损伤的发生率较低,差异具有统计学的意义,P〈0.05。比较组间手术时间、术中出血量、术后引流量以及术后引流时间等指标,观察组手术时间长于对照组（P〈0.05）,其余各指对比,差异均不具有统计学意义（P〉0.05）。结论 在行甲状腺的手术时,术中对喉返神经的精细解剖以及显露可以明显减小患者喉返神经的损伤率,对预防喉返神经的损伤具有重要的临床意义。Objective To investigate the clinical effect and significance of anatomy and reveal recurrent laryngeal nerve in thyroid surgery to reduce its injury. Methods A retrospective analysis of 196 cases of thyroid surgery in our hospital from March 2010 to March 2015, the recurrent laryngeal nerve was divided into observation group（89 cases） and control group（107 cases）. The patients in the observation group were dissected and revealed the recurrent laryngeal nerve, the control group was treated with conventional surgery without exposing the recurrent laryngeal nerve. The injury of recurrent laryngeal nerve in two groups was compared. Results 3 cases of patients in the observation group after the injury of the recurrent laryngeal nerve, accounting for the proportion of 3.37%. And temporary damage, no permanent damage. In the control group, 12 patients suffered recurrent laryngeal nerve injury, the proportion was about 11.22%, 10 cases were temporary injury, and the other one was permanent injury in 2 cases, compared with the control group, the incidence of neurological injury in the observation group was lower, the difference was statistically significant（P〈0.05）. The operative time, intraoperative blood loss, postoperative drainage volume and postoperative drainage time were compared between groups. The operation time of the observation group was longer than that of the control group（P〈0.05）. The rest of the fingers contrast, the differences were not statistically significant（P〈0.05）. Conclusion In thyroid surgery, intraoperative fine dissection and exposure of recurrent laryngeal nerve can significantly reduce the injury rate of recurrent laryngeal nerve, it has important clinical significance in prevention of recurrent laryngeal nerve injury.

关 键 词：甲状腺切除手术 显露喉返神经 喉返神经损伤 

分 类 号：R653[医药卫生—外科学]