甲状腺微小癌的手术方式及减少喉返神经损伤的临床分析  

Surgical Treatment of Thyroid Microcarcinoma and Reduction of Recurrent Laryngeal Nerve Injury

作　　者：吴德虎 WU Dehu(Gaizhou Central Hospital,Yingkou 115200,China)

机构地区：[1]盖州市中心医院,辽宁营口115200

出　　处：《中国医药指南》2021年第33期80-82,共3页Guide of China Medicine

摘　　要：目的本次研究旨在对甲状腺微小癌手术方式的选择以及减少喉返神经损伤的方法进行了探讨分析。方法以我院近年所接治的200例甲状腺微小癌患者作为研究对象,对两组对象诊治方式进行记录分析。结果对200例研究对象均进行随访,随访时间不等,其中术后出现喉返神经损伤患者合计5例,其中4例出自未显露患者神经的手术患者;1例出自显露喉返神经的手术患者。5例喉返神经损伤患者皆为单侧损伤,经由对症处理后,声嘶情况均得以好转。喉返神经显露组以及喉返神经未显露组在喉返神经损伤发生率数据比较上并无显著差异(P>0.05)。5例患者局部复发,复发率为2.50%。其中2例患者为患侧腺叶、峡部、对侧腺叶次全切除术后对侧腺叶复发,余下3例为局部淋巴结复发。上述5例患者经由再次手术切除后,未见复发。其余195例患者均情况良好,无转移、复发或是死亡情况。结论在甲状腺微小癌的诊断之中,高分辨率彩超、细针穿刺活检以及术中冰冻病理检查均属可靠的诊断方法,手术是治疗该病是理想的方式。医师需结合实际情况,合理选择手术方式,确保长期疗效。术中显露喉返神经并加强各项保护措施,是减少喉返神经损伤的有效方法。Objective The purpose of this study was to explore the selection of surgical methods for thyroid microcarcinoma and to reduce the injury of recurrent laryngeal nerve.Methods Two hundred cases of thyroid microcarcinoma treated in our hospital in recent years were taken as the study object,and the diagnosis and treatment of the two groups were recorded and analyzed.Results Two hundred cases subjects were followed up for different time,including 5 patients with recurrent laryngeal nerve(RLN)injury,4 patients without RLN exposure;1 patient underwent operation to expose recurrent laryngeal nerve.The recurrent laryngeal nerve injury was unilateral.After symptomatic treatment,the hoarseness was improved.There was no significant difference in the incidence of recurrent laryngeal nerve injury between the exposed recurrent laryngeal nerve group and the non-exposed recurrent laryngeal nerve group(P>0.05).Local recurrence was found in 5 patients(2.50%).In 2 cases,the contralateral gland lobe recurred after subtotal resection of the affected gland lobe,isthmus and contralateral gland lobe,and in the remaining 3 cases local lymph node recurred.All 5 cases were resected and no recurrence was found.The other 195 patients were in good condition without metastasis,recurrence or death.Conclusion In the diagnosis of thyroid microcarcinoma,high-resolution color doppler ultrasound,fine needle aspiration biopsy and intraoperative frozen pathological examination are reliable diagnostic methods.Surgery is the ideal way to treat the disease.Physicians need to choose surgical methods reasonably based on actual conditions to ensure long-term results.Exposing the recurrent laryngeal nerve during the operation and strengthening various protective measures are effective methods to reduce the damage of the recurrent laryngeal nerve.

关 键 词：甲状腺微小癌 手术方式 喉返神经损伤 

分 类 号：R736.1[医药卫生—肿瘤]