神经监测气管导管对甲状腺癌双侧颈淋巴结清扫术患者喉返神经的保护作用  

Protective effect of nerve monitoring tracheal catheter on recurrent laryngeal nerve in patients with thyroid cancer undergoing bilateral neck lymph node dissection

作　　者：李晓旭[1] 宋德霸[1] 曹武杰 张晓剑[1] 王明佳[1] Li Xiaoxu;Song Deba;Cao Wujie;Zhang Xiaojian;Wang Mingjia(Department of Thyroid and Breast Surgery,the First People's Hospital of Shangqiu,Shangqiu 476100,China)

机构地区：[1]商丘市第一人民医院甲状腺乳腺外科,商丘476100

出　　处：《中华普通外科杂志》2024年第2期121-125,共5页Chinese Journal of General Surgery

摘　　要：目的分析神经气管导管监测对甲状腺癌双侧颈淋巴结清扫术患者喉返神经的保护作用。方法回顾性分析2019年7月至2022年8月于商丘市第一人民医院接受甲状腺癌双侧颈淋巴结清扫术92例患者的临床资料,按术中神经监测气管导管方式不同分为对照组(常规暴露,52例)和研究组(术中接受神经气管导管监测,40例)。结果研究组术中出血量[(12.3±3.3)ml]少于对照组[(16.9±4.0)ml],喉返神经探查暴露时间[(8.7±2.6)min]、手术时间[(4.0±0.8)h]、术后住院时间[(3.2±0.9)d]均短于对照组[(14.4±3.6)min、(4.5±1.2)h、(5.7±1.3)d](t=5.770、8.391、2.387、10.853,均P<0.05);研究组术后1个月振幅微扰(4.85%±0.58%)、基频微扰(0.28%±0.17%)、标准化噪声能量[(-20.3±4.4)dB]、嗓音障碍指数量表简版评分[(1.6±0.5)分]、癌症患者生命质量量表评分[(43.7±4.8)分]均低于对照组[(3.05%±0.54%)、(0.42%±0.16%)、(-14.6±3.3)dB、(3.3±0.4)分、(50.4±5.6)分],谐波噪声比[(24.9±4.1)dB]高于对照组[(20.3±4.4)dB](t=10.446、4.049、7.036、19.076、6.116、5.144,均P<0.001);研究组术后并发症发生率(8%)低于对照组(23%)(χ^(2)=4.020,P=0.045)。结论神经气管导管监测用于甲状腺癌双侧颈淋巴结清扫术中可改善患者声带功能,减轻喉返神经损伤,降低嗓音障碍程度,提高患者的生活质量。Objective To analyze the protective effect of neurotracheal catheter monitoring on recurrent laryngeal nerve in patients with bilateral cervical lymph node dissection of thyroid cancer.Methods The clinical data of 92 patients undergoing bilateral cervical lymph node dissection for thyroid cancer at the First People's Hospital of Shangqiu from Jul 2019 to Aug 2022 were retrospectively analyzed.Patients were divided into control group(routine exposure,52 cases)and study group(intraoperative neurotrachatic catheter monitoring,40 cases)The general data,perioperative indicators,parathyroid function,vocal cord function,voice disorder index,quality of life and postoperative complications were compared between the two groups.Results The intraoperative blood loss in the study group[(12.3±3.3)ml]was less than that in the control group[(16.9±4.0)ml].The exposure time[(8.7±2.6)min],operation time[(4.0±0.8)h]and postoperative hospitalization time[(3.2±0.9)d]were shorter than those of control group[(14.4±3.6)min,(4.5±1.2)h,(5.7±1.3)d](t=5.770,8.391,2.387,10.853,all P<0.05);Amplitude perturbation(4.85%±0.58%),fundamental frequency perturbation(0.28%±0.17%),standardized noise energy[(-20.3±4.4)dB],VHI-10 score[(1.6±0.5)score],Quality of life scale for cancer patients 1 month after surgery the TG-V4 score[(43.7±4.8)points]was lower than that of control group[(3.05%±0.54%),(0.42%±0.16%),(-14.6±3.3)dB,(3.3±0.4)points,(50.4±5.6)points].The harmonic noise ratio[(24.9±4.1)dB]was higher than that of the control group[(20.3±4.4)dB](t=10.446,4.049,7.036,19.076,6.116,5.144,all P<0.001);The incidence of postoperative complications in the study group(8%)was lower than that in the control group(23%)(χ^(2)=4.020,P=0.045).Conclusion Neurotracheal catheter monitoring during bilateral cervical lymph node dissection for thyroid cancer can improve vocal cord function,reduce recurrent laryngeal nerve injury,reduce voice disturbance and improve quality of life.

关 键 词：甲状腺肿瘤 喉返神经 淋巴结切除术 神经气管导管监测 

分 类 号：R736.1[医药卫生—肿瘤]