喉返神经监测技术在全腔镜cT_1N_(0～1a)分化型甲状腺癌根治术中的应用体会  

Application of intraoperative neuromonitoring technique in totally endoscopic radical thyroidectomy for cT_1N_(0-1a) differentiated thyroid cancer

作　　者：费阳[1] 姚京[1] 王世斌[1] 田文[2] 

机构地区：[1]中国人民解放军总医院第一附属医院,北京100048 [2]中国人民解放军总医院

出　　处：《腹腔镜外科杂志》2017年第11期801-805,共5页Journal of Laparoscopic Surgery

基　　金：北京市科技计划项目(编号:Z141107002514102)

摘　　要：目的:探讨喉返神经监测技术在全腔镜cT_1N_(0~1a)甲状腺癌根治手术中应用的必要性。方法:对比分析2013年2月至2016年10月完成的106例全腔镜cT_1N_(0~1a)分化型甲状腺癌根治术的临床资料,其中神经监测组54例,未监测组52例。对比分析两组喉返神经的辨识时间、辨识率、暂时性损伤及永久性损伤的差异。结果:非神经监测组中1例因误断喉不返神经而中转开放行神经吻合术;其他患者均顺利完成全腔镜手术。神经监测组在喉返神经辨识时间、辨识率方面明显优于未监测组,两组相比差异有统计学意义(P<0.05)。未监测组中7条喉返神经未能明确确认。神经监测组中2条喉返神经发生暂时性损伤,其中1条于术后2周内恢复,另1条于术后4周恢复;未监测组中8条喉返神经出现暂时性损伤,其中6条于术后2周内恢复,2条于术后4周内恢复;在喉返神经暂时性损伤方面两组差异有统计学意义(P<0.05)。在喉返神经永久性损伤方面两组差异无统计学意义(P>0.05)。结论:喉返神经监测技术是cT_1N_(0~1a)甲状腺癌全腔镜根治手术的有效补充,可快速、有效定位喉返神经,避免出现神经损伤的严重并发症,尤其在全腔镜甲状腺癌根治术开展初期是不可或缺的。Objective：To explore the necessity of intraoperative neuromonitoring of recurrent laryngeal nerve in the endoscopic radical thyroidectomy for differentiated thyroid cancer in the cT1N0-1a stage.Methods：Clinical data of 106 patients who underwent endoscopic radical thyroidectomy for the cT1N0-1a differentiated thyroid cancer from Feb.2013 to Oct.2016 were analyzed comparatively.54 patients used intraoperative neuromonitoring of recurrent laryngeal nerve and 52 patients did not use this technique.The data of the two groups were compared in the aspects of identifying time of recurrent laryngeal nerve,identifying rate,temporary injury and permanent injury.Results：Only 1 patient without neuromonitoring underwent conversion to open surgery because non-recurrent laryngeal nerve was cut off by mistake and neural anastomosis was performed.All the other patients successfully received endoscopic procedures.In the identifying time and identifying rate of recurrent laryngeal nerve,the group using intraoperative neuromonitoring technique was superior to the group not using this technique,and the differences were statistically significant （P ＜ 0.05）.7 recurrent laryngeal nerves were not identified definitely in the group not using intraoperative neuromonitoring.2 recurrent laryngeal nerves in the group using intraoperative neuromonitoring had temporary injury and recovered in 2 weeks or 4 weeks postoperatively.8 recurrent laryngeal nerves in the group not using this technique had temporary injury,6 nerves recovered in 2 weeks and 2 nerves recovered in 4 weeks postoperatively.There was statistical significance in the difference of temporary nerve injury between the 2 groups （P ＜ 0.05）.However,there was no statistically significant difference in the permanent nerve injury between the 2 groups （P ＞ 0.05）.Conclusions：Intraoperative neuromonitoring technique of recurrent laryngeal nerve could provide guarantee for safe and rapid identification of nerve and avoid severe complication of nerve injury.Especiall

关 键 词：甲状腺肿瘤 内窥镜检查 术中神经监测 

分 类 号：R736.1[医药卫生—肿瘤]