甲状腺腺叶切除术两种显露喉返神经方法的临床疗效  

Clinical analysis of two surgical methods of exposing recurrent laryngeal nerve in thyroidectomy

作　　者：梁龙[1] 苏民富 李嘉根 Liang Long;Su Minfu;Li Jiagen(Department of Head and neck surgery,Huainan Chaoyang Hospital,Zhejiang 232000,China;Ningbo Yinzhou People’s Hospital,Zhejiang 315040,China)

机构地区：[1]淮南市朝阳医院头颈外科,232000 [2]宁波市鄞州人民医院,315040

出　　处：《中华普外科手术学杂志（电子版）》2021年第6期680-682,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：浙江省医药卫生科技计划项目(2017KY613)。

摘　　要：目的比较甲状腺腺叶切除术两种显露喉返神经(RLN)方法的临床效果。方法回顾性分析80例甲状腺腺叶切除术患者资料,根据不同术式分为两组,予以精细化被膜解剖结合环甲隙显露RLN(精细组)和常规术甲状腺下动脉显露RLN(常规组),各40例。采用SPSS 23.0软件进行分析,两组患者术中术后各项指标、治疗前后血清甲状旁腺激素(PTH)和Ca^(2+)等计量资料采用(x±s)表示,独立样本t检验;两组患者甲状旁腺、RLN损伤等并发症发生率采用χ^(2)检验比较。P<0.05差异有统计学意义。结果两组患者手术时间、术中出血量、疼痛评分、引流量、住院时间差异均无统计学意义(P>0.05)。两组患者术前血清PTH和Ca^(2+)水平差异无统计学意义(P>0.05),术后常规组PTH和Ca^(2+)均明显低于精细组(P<0.05)。常规组患者术后暂时性甲状旁腺损伤10.0%和RLN损伤发生率7.5%均明显高于精细组(均为0%)P<0.05。结论甲状腺腺叶切除术两种显露RLN方法均具有良好的治疗效果,但精细化被膜解剖结合环甲隙显露喉返神经可降低治疗后暂时性RLN损伤和甲状旁腺损伤的发生率。Objective To compare the clinical outcome of two surgical methods of exposing recurrent laryngeal nerve(RLN)in thyroidectomy.Methods The clinical data of 80 patients underwent thyroidectomy were analyzed retrospectively.According to the surgical methods,40 cases were divided into the fine group who received the fine tunica anatomy with exposing the RLN in the cricothyroid space,while 40 cases were divided into the conventional group who received the conventional surgical exposure of RLN under the inferior thyroid artery.Statistical analysis were performed by using SPSS 23.0 software.Measurement data such as intraoperative and postoperative indexes,serum parathyroid hormone(PTH)and Ca^(2+) level before and after surgery were expressed as,and were examined by using t test.The incidence of complications such as parathyroid and RLN injury were examined by usingχ^(2) test.A P value of<0.05 was considered as statistically significant difference.Results There were no significant difference between the fine group and the conventional group in terms of the operation time,intraoperative blood loss,pain score,drainage volume and the length of hospitalization(P>0.05).There was no significant difference between the two groups in terms of serum PTH and Ca^(2+) levels before operation(P>0.05),however the PTH and Ca^(2+) levels in the conventional group were significantly lower than those in the fine group after operation respectively(P<0.05).Compared with the fine group,the incidence of temporary parathyroid injury of 10%and RLN injury of 7.5%in the conventional group were significantly higher(P<0.05).Conclusion Both two surgical methods of exposing RLN in thyroidectomy could achieve good therapeutic effect,but the fine tunica anatomy with exposing the RLN in the cricothyroid space could reduce the incidence of temporary RLN and parathyroid injury after surgery.

关 键 词：甲状腺切除术 喉返神经 喉返神经显露术 精细化被膜解剖 环甲隙显露术 疗效比较研究 

分 类 号：R65[医药卫生—外科学]