甲状腺全切及双侧中央区淋巴结清扫后创腔运用铜绿假单胞菌注射液局部喷洒对喉返神经的影响  

Effect of local spraying of Pseudomonas aeruginosa injection on recurrent laryngeal nerve after total thyroidectomy and bilateral central lymph node dissection

作　　者：马宇[1] 曾翠芳[1] 邹秀和[1] 雷建勇[1] 郑洵 李志辉[1] 龚日祥[1] 朱精强[1] 魏涛[1] MA Yu;ZENG Cuifang;ZOu Xiuhe;LEI Jianyong;ZHENG Xun;LI Zhihui;GONG Rixiang;ZHU Jingqiang;WEI Tao(Department of Thyroid and Parathyroid Surgery Center,West China Hospital,Sitchuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西医院甲状(旁)腺外科中心,成都610041

出　　处：《中国普外基础与临床杂志》2020年第12期1496-1500,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省科技厅项目(项目编号:2019JDKP0071)。

摘　　要：目的探讨甲状腺癌行中央区淋巴结清扫术后局部喷洒铜绿假单胞菌注射液是否损伤喉返神经(RLN)和甲状旁腺。方法113例甲状腺乳头状癌患者,分为局部喷洒组58例和对照组55例。2组均行甲状腺全切及双侧中央区淋巴结清扫,局部喷洒组术毕关闭切口前于创面喷洒1 mL铜绿假单胞菌注射液,对照组喷洒1 mL生理盐水。观察2组患者术中喉返神经和迷走神经电位信号以及术后声音嘶哑和甲状旁腺功能低下的发生率,比较术后2组的引流量,乳糜漏、术后出血、感染和发热发生情况以及术后住院时间。结果2组患者的年龄、性别、体质量指数、肿瘤部位、肿瘤直径等基线资料方面的差异均无统计学意义(P>0.05)。2组患者手术后未发生临时性和永久性声音嘶哑,未发生永久性甲状旁腺功能减退症。局部喷洒组术后24 h引流量多于对照组,差异有统计学意义(P=0.023)。对照组术后出现2例乳糜漏,经保守治疗痊愈;观察组无乳糜漏发生,但差异无统计学意义(P>0.05)。2组患者在淋巴结清扫数目、术后总引流量、发热和切口感染发生率、术后住院时间、术后疼痛评分、甲状旁腺功能减退等方面比较差异均无统计学意义(P>0.05)。结论甲状腺癌行甲状腺全切及双侧中央区淋巴结清扫术后在创腔使用铜绿假单胞菌注射液局部喷洒是安全的,不会损伤喉返神经。Objective To evaluate the safty of recurrent laryngeal nerve(RLN)and parathyroid if Pseudomonas aeruginosa injection(PAI)is used after total thyroidectomy and central neck dissection(CND).Methods From Mar.2016 to Oct.2017,we recruited 113 patients with papillary thyroid cancer(PTC)who accepted Total thyroidectomy and CND.During operation,1 mL of PAI was applied in 58 patients(local spray group)and 55 not(control group).The hoarseness,hypoparathyroidism,chylous fistula,drainage volume,hospital stay,and incidence of complications were compared between the two groups.Results The two groups embraced few difference in age,gender,BMI,tumor site,the diameter of tumor and the number of metastatic and the harvested lymph nodes(P>0.05).There were nobody who has suffered in hoarseness and permanent hypoparathyroidism in both groups at any time after operation.There was no significant differences of complication between the two groups.The drainage volume at 24 h after operation in the local spraying group was more than that in the control group,and the difference was statistically significant(P=0.023).There were 2 patients had chylous fistula after surgery in the control group but none in the local spray group.The total volumes of drainage,incidence of fever and incision infection,the mean stay in the hospital,and the postoperative pain score had no statistic significance in the both groups.Conclusion After total thyroidectomy and CND,local spraying of PAI in the wound cavity is safe and will not damage the recurrent laryngeal nerve.

关 键 词：甲状腺乳头状癌 中央区淋巴结清扫 喉返神经 铜绿假单胞菌注射液 局部喷洒 

分 类 号：R736.1[医药卫生—肿瘤]