甲状腺癌淋巴结清扫中喉返神经损伤的影响因素分析及超声刀的应用价值  

Analysis of the Influencing Factors of Recurrent Laryngeal Nerve Injury During Thyroid Cancer Lymph Node Dissection and the Applicative Value of Ultrasonic Scalpel

作　　者：纪璟 王汉晋[1] 笪霞 徐锦[1] 唐崇寅 王国柱[1] JI Jing;WANG Hanjin;DA Xia;XU Jin;TANG Chongyin;WANG Guozhu(Department of General Surgery,(Nanjing First Hospital),Nanjing Medical University(Nanjing First Hospital),Nanjing Jiangsu 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)普外科,江苏南京210006

出　　处：《联勤军事医学》2023年第11期940-943,共4页Military Medicine of Joint Logistics

基　　金：南京市卫生科技发展专项资金项目(YKK20113)。

摘　　要：目的研究甲状腺癌淋巴结清扫中喉返神经损伤的影响因素分析及超声刀的应用价值。方法选取2020-01/2021-12月在作者医院诊断并进行治疗的210例甲状腺癌患者作为研究对象。按照患者的入院顺序编号,使用随机数字表法将患者随机分为观察组和对照组,每组各105例。观察组患者采用超声刀进行手术,对照组患者采用常规手术刀进行手术。比较两组患者的围手术期各项指标、不良反应的差异。依据患者是否发生喉返神经损伤将患者分为损伤组(n=18)和未损伤组(n=192)。采用Logistic回归分析探讨甲状腺癌淋巴结清扫中喉返神经损伤的影响因素。结果观察组患者的手术时间、手术切口长度、24h引流量、术后总引流量以及住院时间显著低于对照组(P均<0.05);观察组患者发生甲状旁腺功能低下以及喉返神经损伤情况显著低于对照组(P均<0.05)。喉返神经未损伤组患者操作原则更多采用是精细化被膜解剖法,更多采用自喉返神经解剖三角的分离方式,手术范围更保守(P均<0.01)。Logis-tic回归分析结果显示,术中非精细化被膜解剖法、自甲状腺下角分离、手术范围广泛均是造成患者喉返神经损伤的危险因素。结论超声刀在甲状腺癌淋巴结清扫术中对于喉返神经损伤较小,在术中非精细化被膜解剖法、自甲状腺下角分离、手术范围广泛是造成患者喉返神经损伤的危险因素。Objective To analyze the influencing factors of recurrent laryngeal nerve injury in thyroid cancer lymph node dissection and evaluate the applicative value of ultrasonic scalpel.Methods A total of 210 patients diagnosed and treated for thyroid cancer in the author′s hospital from January 2020 to December 2021 were selected as the study subjects.The patients were divided into observation group and control group,with 105 patients in each,according to the patient′s admission number by thier admission sequence number.The patients in the observation group underwent surgical treatment by ultrasonic scalpel,while those in the control group underwent surgical treatment by conventional scalpel.The differences in perioperative indicators and adverse reactions between the two groups were compared.The patients were divided into injury group(n=18)and non-injury group(n=192)according to whether laryngeal nerve injury occured.The influencing factors of recurrent laryngeal nerve injury during lymph node dissection for thyroid cancer were analyzed by Logistic regression.Results The operation time,length of surgical incision,24 h drainage volume,total postoperative drainage volume and length of hospitalization in the observation group were significantly lower than those in the control group(all P<0.05);the incidences of hypoparathyroidism and recurrent laryngeal nerve injury in the observation group was significantly lower than those in the control group(all P<0.05).The operation principle of the patients without recurrent laryngeal nerve injury was more refined capsule dissection,the dissection method from the anatomical triangle of recurrent laryngeal nerve was more used,and the surgical scope was more conservative(all P<0.01).Logistic regression analysis showed that non-meticulous capsule dissection,dissection from the inferior horn of the thyroid and extensive surgical scope were risk factors for recurrent laryngeal nerve injury.Conclusion Ultrasonic scalpel has less damage to recurrent laryngeal nerve in thyroid cancer ly

关 键 词：超声刀 甲状腺癌 喉返神经损伤 危险因素 

分 类 号：R736.1[医药卫生—肿瘤]