甲状腺术前选择性喉镜检查替代常规喉镜检查可行性分析  

The possibility of selective rather than routine preoperative laryngoscopy in thyroid surgery

作　　者：高翔[1] 魏兴梅 胡亚[1] 廖泉[1] GAO Xiang;WEI Xing-mei;HU Ya(Department of General Surgery,Peking Union Medical College Hospital,Peking Union Medical College&Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院基本外科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院耳鼻咽喉头颈外科,北京100730

出　　处：《中国实用外科杂志》2020年第10期1202-1204,1206,共4页Chinese Journal of Practical Surgery

摘　　要：目的探讨甲状腺手术病人术前选择性喉镜检查替代常规喉镜检查的可行性。方法回顾性分析2018年1—12月北京协和医院收治的行术前喉镜检查的1906例甲状腺手术病人的临床资料,分析术前声带麻痹的影响因素。结果仅18例(0.9%)病人发现术前声带麻痹。多因素分析表明,术前声音嘶哑(OR=19.094,95%CI 6.270~58.146,P<0.001)、结节位于后被膜(OR=27.976,95%CI 2.995~261.368,P=0.003)、既往有颈部手术史(OR=12.032,95%CI 2.058~261.368,P=0.006)为甲状腺术前声带麻痹的独立危险因素。术前有619例(32.5%)病人至少具备1个独立危险因素,其术前声带麻痹的发生率为2.9%(18/619)。如以选择性喉镜替代常规喉镜,1287例(67.5%)病人不必行术前喉镜检查,同时未遗漏术前声带麻痹的病人。结论甲状腺手术病人术前声带麻痹的发生率较低,可选择性针对有独立危险因素的病人行术前喉镜检查。ObjectiveTo analyze the necessity of routine laryngoscopy and the possibility of selective laryngoscopy forthyroid surgery.MethodsThe clinical data of 1906 patients who had performed pre-thyroidectomy laryngoscopy inPeking Union Medical College Hospital from January to December 2018 were analyzed retrospectively.Based on thepreoperative laryngoscopy findings,the patients were divided into 2 groups:normal-vocal cord(NVC)group and vocalcord palsy(VCP)group.Univariate and multivariate logistic regression analyses were used to evaluate the associationbetween the clinical variables and VCP.ResultsOnly 18(0.94%)patients were found to have a VCP with the pre-operative laryngoscopy.Using multivariate analysis by logistic regression,only presence of hoarseness(OR=19.094,95%CI 6.270—58.146,P<0.001),nodule located in the posterior capsular(OR=27.976,95%CI 2.995—261.368,P=0.003)and previous neck surgery(OR=12.032,95%CI 2.058—261.368,P=0.006)were independent risk factors of pre-operative VCP.In the study,619(32.5%)patients had at least one independent risk factors,in which the incidence ofVCP was 2.9%(18/619).If selective rather than routine preoperative laryngoscopy was implemented,1287(67.5%)ofpatients would not have required preoperative laryngoscopy without missing a diagnosis of VCP.Conclusion Preoperative VCP is rare,and a selective preoperative laryngoscopy should be applied in those patients who hasindependent risk factors.

关 键 词：甲状腺手术 声带麻痹 喉镜 喉返神经损伤 

分 类 号：R6[医药卫生—外科学]