水性分离法显露喉返神经在甲状腺手术中的应用  

Application of hydrodissection to expose recurrent laryngeal nerve during thyroid surgery

作　　者：叶剑 冯剑平 谭健辉 黄永胜 潘小梅 唐诗彬 Ye Jian;Feng Jianping;Tan Jianhui;Huang Yongsheng;Pan Xiaomei;Tang Shibin(Thyrovascula r Surgery,Shunde Hospital of Southern Medical University(the First People’s Hospital of Shunde District,Foshan),528308 Foshan,China)

机构地区：[1]南方医科大学顺德医院(佛山市顺德区第一人民医院)甲状腺血管外科,佛山528308

出　　处：《新医学》2023年第4期272-276,共5页Journal of New Medicine

基　　金：佛山市卫生和计生局医学科研课题项目(20190357)。

摘　　要：目的探讨水性分离法显露喉返神经在甲状腺手术中的应用价值。方法将70例甲状腺手术患者随机分为分离组和对照组,各35例。分离组应用生理盐水局部注射方法显露喉返神经,对照组应用钝性分离方法显露喉返神经。比较2组的手术时间、出血量、住院时间、喉返神经显露时间、喉返神经受损发生率、低钙血症发生率。结果分离组共显露喉返神经46条,对照组共显露喉返神经54条,术者发现采用水性分离方法显露喉返神经能更清晰辨清喉返神经的走向。分离组出现暂时性喉返神经损伤1例,对照组5例,比较差异无统计学意义(P>0.05),2组均无出现永久性喉返神经损伤者。2组的喉返神经显露时间、手术时间、出血量、低钙血症发生率、住院时间比较差异均无统计学意义(P均>0.05)。结论水性分离法简单易行,有助于更清晰地辨清喉返神经的走向,避免了过度剥离神经的机械损伤,是显露喉返神经的一种安全可靠的方法。Objective To investigate the application value of hydrodissection to expose the recurrent laryngeal nerve in thyroid surgery.Methods Seventy patients undergoing thyroid surgery were randomly divided into the hydrodissection group(n=35)and control group(n=35).In the hydrodissection group,the recurrent laryngeal nerve was exposed by local injection of normal saline.And in the control group,the recurrent laryngeal nerve was exposed by blunt dissection.The operation time,blood loss,length of hospital stay,exposure time of recurrent laryngeal nerve,incidence rates of recurrent laryngeal nerve injury and hypocalcemia were compared between two groups.Results 46 recurrent laryngeal nerves were exposed in the hydrodissection group and 54 in the control group.Surgeons found that hydrodissection could more explicitly display the course of recurrent laryngeal nerve.One case of temporary recurrent laryngeal nerve injury occurred in the hydrodissection group and five cases in the control group,and the difference was not statistically significant(P>0.05).No permanent recurrent laryngeal nerve injury was observed in both groups.The exposure time of recurrent laryngeal nerve,operation time,blood loss,incidence rate of hypocalcemia and length of hospital stay did not significantly differ between two groups,and the differences were not statistically significant(all P>0.05).Conclusion It is convenient and simple to expose the recurrent laryngeal nerve through hydrodissection.As a safe and reliable Method to expose the recurrent laryngeal nerve,hydrodissection ca n accurately identify the course of the recurrent laryngeal nerve and avoid mechanical injury induced by excessive dissection of the nerve.

关 键 词：甲状腺手术 喉返神经显露 喉返神经损伤 水性分离 

分 类 号：R653[医药卫生—外科学]