甲状腺癌术后早期残留甲状腺再次手术中喉返神经监测的作用  

Effects of intraoperative laryngeal nerve monitoring for early reoperation of residual thyroid after thyroidectomy in the patient with thyroid cancer

作　　者：李辉[1] 龙淼云[2] 黎洪浩[2] LI Hui;LONG Miaoyun;LI Honghao(Department of Surgery,Dongguang Qiaotou Hospital,Guangdong 523520;Department of Thyroid Surgery,Sun Yat-sen Hospital,Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]东莞市桥头医院外三科,广东东莞523520 [2]中山大学孙逸仙纪念医院甲状腺外科,广州510287

出　　处：《岭南现代临床外科》2018年第4期405-408,413,共5页Lingnan Modern Clinics in Surgery

摘　　要：目的探讨术中神经监测术在甲状腺癌术后5~15天行残留甲状腺切除术中的应用,对术后血清甲状腺球蛋白、喉返神经及甲状旁腺功能的影响。方法回顾性分析中山大学孙逸仙纪念医院甲状腺外科2010年1月至2016年12月甲状腺手术的患者资料,对符合纳入标准的病例进行分析,并根据术中是否使用神经监测术分为神经监测组和非神经监测组,统计分析术后暂时性及永久性喉返神经损伤性声音嘶哑、暂时性及永久性甲状旁腺功能低下发生率、术前及术后血清甲状腺球蛋白(Tg)浓度。结果符合纳入标准患者435例,其中神经监测组227例、非神经监测组208例。神经监测组平均术前血清Tg浓度为18.66±2.3 ng/mL,非神经监测组平均术前Tg浓度为17.43±1.4 ng/mL,差异无统计学意义(P<0.05)。非神经监测组8.67%(18/208)患者出现暂时性声嘶,神经监测组2.2%(5/227)患者出现暂时性声嘶,有统计学差异(P<0.05)。非神经监测组1.92%(4/208)患者出现永久性声嘶,神经监测组0.44%(1/227)患者出现永久性声嘶,无统计学差异(P>0.05);非神经监测组18.75%(39/208)患者出现暂时性甲状旁腺功能减退,神经监测组7.49%(17/227)患者出现暂时性甲状旁腺功能减退,有统计学差异(P<0.05);非神经监测组1.92%(4/208)患者出现永久性甲状旁腺功能减退,神经监测组0.88%(2/227)患者出现永久性甲状旁腺功能减退,两组比较没有统计学差异(P>0.05)。非神经监测组术后1月平均Tg浓度为2.82±0.2 ng/mL,神经监测组术后1月平均Tg浓度为1.37±0.2 ng/mL,有统计学差异(P<0.05)。非神经监测组45.06%(94/208)患者术后1个月平均Tg浓度小于1 ng/mL,神经监测组67.4%(153/227)患者术后1个月平均Tg浓度为小于1 ng/mL,有统计学差异(P<0.05)。结论残留甲状腺切除术中应用术中神经监测术可降低喉返神经损伤及甲状旁腺功能低下发生率,提高残留甲状腺组织及癌组织切除的彻底性,可将初Objective To investigate the effects of intraoperative nerve monitoring on early reoperation of residual thyroid after 5 to 15 days of thyroidectomy for thyroid cancer,and the level of postoperative serum thyroglobulin,recurrent laryngeal nerve injury and parathyroid gland function.Methods We retrospectively analyzed the data of a group of patients with thyroid surgery from January 2010 to December 2016 in Sun Yat-sen Memorial Hospital of Sun Yat-sen University.The patients who met the inclusion criteria were assigned to the nerve monitoring group and the non-neural monitoring group according to whether the nerve monitoring was used during the operation.The postoperative temporary and permanent recurrent laryngeal nerve injury were recorded.The hypoparathyroidism,the levels of preoperative and postoperative serum thyroglobulin(Tg)were detected.Results There were 435 patients who met the inclusion criteria,including 227 in the nerve monitoring group and 208 in the non-neural monitoring group.The average preoperative serum Tg concentration in the nerve monitoring group was 18.66±2.3 ng/ml,and 17.43±1.4 ng/ml in the non-neural,which was not statistically significant(P<0.05).Temporary hoarseness occurred in 18 cases(18/208,8.67%)in the non-neural monitoring group,and in 5 cases(5/227,2.2%)in the nerve monitoring group(P<0.05).Non-neural monitoring group had permanent hoarseness in 4 cases(4/208,1.92%),and in one case(1/227,0.44%)in the nerve monitoring group(P>0.05).Thirty-eight cases(39/208,18.75%)in non-neural monitoring group had transient hypoparathyroidism,and 17 cases(17/227,7.49%)in the nerve monitoring group(P<0.05);Four cases(4/208,1.92%)in non-neural monitoring group had permanent hypoparathyroidism,and two(2/227,0.88%)in the nerve monitoring group(P>0.05).The average Tg concentration in the non-neural monitoring group was 2.82±0.2 ng/ml in 1 month after operation,and 1.37±0.2 ng/ml in the nerve monitoring group(P<0.05).In the non-neural monitoring group,45.06%(94/208)patients had an average Tg concentr

关 键 词：神经检测 甲状腺手术 喉返神经 

分 类 号：R653[医药卫生—外科学]