腔镜与开放甲状腺腺叶切除术中喉返神经全程显露的对比研究  

Comparative study of the exposure of the whole Recurrent Laryngeal Nerve in Endoscopic and Open Thyroidectomy

作　　者：谢书勤[1] 卢强[1] 欧阳杰[1] 梁卓虹[1] 李爱辉[1] 廖爱毛[1] 李洪[1] 王力斌[1] XIE Shuqin LU Qiang OU Yangfie LIANG Zhuohong LI Aihui LIAO Aimao LI Hong WANG Libin(Department of Oneologieal Sur- gery, Dongguan Tungwah Hospital, Dongguan 523110, China)

机构地区：[1]中山大学附属东莞东华医院肿瘤外科,广东东莞523110

出　　处：《宁夏医学杂志》2017年第6期518-521,共4页Ningxia Medical Journal

摘　　要：目的通过对比研究,探讨腔镜下行喉返神经探查术的安全性及腔镜下喉段喉返神经全程显露的技巧。方法收集202例腔镜下或开放下行甲状腺腺叶切除联合喉返神经喉段全层解剖术的病例资料,分析比较腔镜组和开放组的喉返神经解剖入路、手术时间、出血量、喉返神经损伤相关并发症发生率等指标。结果腔镜组82例,行单侧腺叶切除60例,双侧腺叶切除22例,共解剖喉返神经104条,其中选择上入路62条,外入路18条,下入路24条;开放组120例,行单侧腺叶切除术92例,双侧腺叶切除28例,共解剖喉返神经148条,其中选择上入路68条,外入路48条,下入路32条,2组选择入路构成比差异有统计学意义(P<0.05)。腔镜组平均手术时间(78.29±16.58)min,平均出血量(34.94±18.42)m L,术后出现暂时性声音嘶哑2例,均为双侧腺叶切除术患者。开放组平均手术时间(76.67±14.15)min,平均出血量(36.17±16.90)m L,术后暂时性声音嘶哑2例,其中1例为双侧腺叶切除术患者。2组均未出现永久性声嘶患者,各项指标组间比较差异无统计学意义(P>0.05)。结论腔镜下甲状腺腺叶切除术中喉返神经全层显露是安全可行的。3种入路均是喉返神经显露的有效途径,上入路喉返神经的解剖位置固定,结合ZT结节识别,是预防喉返神经损伤最可靠的方法。Objective Through the comparative study, the salty of seeking recurrent laryngeal nerve through endoscope and the skill exposing the whole recurrent laryngeal nerve through endoscope were probed. Methods The clinical data was collected, when a to- tal of 202 eases of endoscopic and open thyroideetomy combined with dissection of the whole larynx part of recurrent laryngeal nerve were accomplished. Analyze and compare the index of the endoscopic operation group and the open group, such as the routes in recurrent laryn- geal nerve dissection,the time of bleeding, the occurrence of injured recurrent laryngeal nerve correlative complications. Results The endoscopic group composed of 82eases, in which 60 eases had the unilateral thyroideetomy,22 eases had the bilateral thyroideetomy and 104 recurrent laryngeal nerves were dissected,in which 62 nerves were chosen to be dissected through the superior route, 18 through the external route ,24 through the inferior route. The open group composed of 120eases, in which 92 eases had the unilateral thyroideetomy ,28 eases had the bilateral thyroideetomy and 148 recurrent laryngeal were dissected,in which 68 nerves were chosen to be dissected through the superior route,48 through the external route,32 through the inferior route. There is a statistical difference between the constituent ra- tions of the chosen routes in the two groups（P 〈0.05）. In the endoscopic group,the average operation time was（78.29 ± 16.58） rain,the average amount of bleeding was （ 34.94 ± 18.42 ） mL,2 cases of transient hoarseness were found after operation and they had the bilateral thyroidectomy. In the open group ,the average operation time was （76, 67 ± 14.15 ）min, the average amount of bleeding was （36.17 ± 16.90 ） mL,2 cases of transient hoarseness were found after operation and one of them had the bilateral thyoidectomy. No cases of perpet- ual hoarseness were found in these groups, and there are no statistical significance between the corresponding index of the two groups �

关 键 词：甲状腺腺叶切除术 喉返神经解剖 腔镜 

分 类 号：R653[医药卫生—外科学]