甲状腺再次手术喉返神经损伤的原因及预防策略分析  

Analysis of Causes and Prevention Strategies of Recurrent Laryngeal Nerve Injury in Thyroid Reoperation

作　　者：尹登贵 YIN Denggui(Department of General Surgery,Lufeng People's Hospital,Lufeng,Yunnan Province,651299 China)

机构地区：[1]禄丰市人民医院普外科,云南禄丰651299

出　　处：《中外医疗》2022年第6期1-4,共4页China & Foreign Medical Treatment

基　　金：2021年楚雄医药高等专科学校科研基金项目(校外项目)(2021YYXM15)。

摘　　要：目的探索甲状腺再次手术喉返神经损伤的原因及预防策略。方法方便选取2018年1月—2020年12月在该院诊治的67例甲状腺再次手术患者为研究对象,按照患者是否出现喉返神经损伤划分为损伤组(6例)与非损伤组(61例),探究患者喉返神经损伤发生原因,并提出合理预防措施。结果67例甲状腺再次手术患者进行喉返神经损伤单因素分析可见,喉返神经损伤发生率为8.95%(6/67),其中,右侧手术占比为83.33%(5/6),左侧手术占比为16.66%(1/6),未显露神经占比为66.66%(4/6),显露神经占比为33.33%(2/6),全切占比为100.00%(6/6);非损伤组患者中,右侧手术占比为4.91%(3/61),左侧手术占比为95.08%(58/61),未显露神经占比为26.22%(16/61),显露神经占比为73.77%(45/61),全切占比为4.91%(3/61),部分切除占比为95.08%(58/61);损伤组患者右侧手术、未显露神经、全切术显著高于非损伤组患者,差异有统计学意义(χ^(2)=5.935,P<0.05)。结论甲状腺再次手术喉返神经损伤独立危险因素主要包括手术部位、神经显露情况以及手术方式等,同时还存在诸多相关因素,因此,在手术治疗过程中,临床工作者需提高自身专业能力、熟悉喉返神经组织结构以及做好喉返神经保护措施,尤其术中需进行常规暴露喉返神经,最大程度上降低喉返神经损伤概率,从而优化治疗效果。Objective To explore the causes and preventive strategies of recurrent laryngeal nerve injury after thyroid reoperation.Methods Sixty-seven patients undergoing reoperation of the thyroid gland who were diagnosed and treated in the hospital from January 2018 to December 2020 were conveniently selected as the study objects.According to whether patients have recurrent laryngeal nerve injury,they were divided into injury group(6 cases)and non-injury group(61 cases)to explore the causes of recurrent laryngeal nerve injury,and put forward reasonable preventive measures.Results A univariate analysis of 67 patients with recurrent laryngeal nerve injury showed that the incidence of recurrent laryngeal nerve injury was 8.95%(6/67).Among them,the right side surgery accounted for 83.33%(5/6),the left side surgery accounted for 16.66%(1/6),the unrevealed nerve accounted for 66.66%(4/6),and the exposed nerve accounted for 33.33%(2/6),the proportion of full cut was 100.00%(6/6).In the non-injury group,the right side surgery accounted for 4.91%(3/61),the left side surgery accounted for 95.08%(58/61),and the unexposed nerve accounted for 26.22%(16/61),the proportion of exposed nerves was 73.77%(45/61),the proportion of full resection was 4.91%(3/61),and the proportion of partial resection was 95.08%(58/61).Patients in the injury group with right side surgery,no nerve exposure,and total resection were significantly higher than those in the non-injury group,the difference was statistically significant(χ^(2)=5.935,P<0.05).Conclusion The independent risk factors for recurrent laryngeal nerve injury in thyroid reoperation mainly include the surgical site,nerve exposure,and surgical methods.At the same time,there are many related factors.Therefore,in the process of surgical treatment,clinicians need to improve their professional ability,be familiar with the structure of the recurrent laryngeal nerve,and take protective measures for the recurrent laryngeal nerve.In particular,it is necessary to routinely expose the recur rent laryngeal

关 键 词：甲状腺再次手术 喉返神经损伤 原因 预防策略 

分 类 号：R653[医药卫生—外科学]