食管癌手术喉返神经损伤15例原因分析  

Analysis of causes and prevention of 15 patients with recurrent laryngeal nerve injury in esophageal carcinoma operation

作　　者：刘向阳 

机构地区：[1]偃师市人民医院,河南偃师471900

出　　处：《中国实用神经疾病杂志》2017年第18期90-92,共3页Chinese Journal of Practical Nervous Diseases

摘　　要：目的探讨食管癌手术喉返神经损伤的原因及预防措施。方法抽取食管癌手术患者129例,按照手术方式的不同予以分组,甲组(n=43)行左侧开胸联合胸内吻合术治疗,乙组(n=43)行左侧开胸联合左侧颈部吻合术治疗,丙组(n=43)行右侧开胸联合右侧颈部吻合术治疗,对比3组喉返神经损伤发生率,分析食管癌手术喉返神经损伤原因,并提出预防措施。结果甲组喉返神经损伤1例(2.3%),低于乙组、丙组的6例(14.0%)、8例(18.6%)(均P<0.05)。结论食管癌手术喉返神经损伤的最主要原因是术中清扫喉返神经旁肿大转移淋巴结的操作不佳,而预防喉返神经损伤的关键是充分掌握人体喉返神经生理解剖,保证手术操作精细化,以锐性、钝性分离相结合的方式贴近上段食管癌外膜进行解剖,尽可能选择切口单一术式。Objective To investigate the causes and preventive measures of recurrent laryngeal nerve injury in esophageal cancer.Methods A total of 129 esophageal cancer patients were enrolled in the study.They were grouped according to the different surgical methods.Group A(n=43)was treated by left thoracotomy combined with left cervical anastomosis,group B(n=43)was treated by left thoracotomy combined with left neck anastomosis,and group C(n=43)was treated by right thoracotomy combined with right neck anastomosis.The recurrent laryngeal nerve injury incidence in the three groups were analyzed,the causes and corresponding preventive measures were discussed.Results The incidence of recurrent laryngeal nerve injury in group A was 2.3%(1/43),which was lower than that in group B and group C(14.0%(6/43)and 18.6%(8/43),P<0.05).Conclusion The main reason for esophageal cancer recurrent laryngeal nerve injury is the poor operation of intraoperative esophageal recurrent laryngeal neonatal metastatic lymph nodes,and the key to prevention is to fully grasp the human body's throat neurophysiological anatomy,and to ensure that the fine surgical operation with sharp,blunt separation of the way close to the upper esophageal cancer outer membrane for anatomy,as far as possible to choose a single incision surgery.

关 键 词：食管癌 喉返神经损伤 原因 处理措施 

分 类 号：R735.1[医药卫生—肿瘤]