喉返神经监测在无充气腋窝入路腔镜单侧甲状腺切除+中央区淋巴结清扫术中的应用效果  

Application of recurrent laryngeal nerve monitoring in unilateral thyroidectomy and central lymph node dissection without inflatable axillary approach

作　　者：高一飞 刘根祥 孙长华 周广军 Gao Yifei;Liu Genxiang;Sun Changhua;Zhou Guangjun(Department of General Surgery,The First People's Hospital of Yancheng City,Yancheng Jiangsu Province 224006,China)

机构地区：[1]盐城市第一人民医院普通外科,江苏盐城224006

出　　处：《中华普外科手术学杂志（电子版）》2024年第5期483-486,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：2021年盐城市医学科技发展计划项目(YK2021055)。

摘　　要：目的:探究喉返神经(RLN)监测在无充气腋窝入路腔镜单侧甲状腺切除+中央区淋巴结清扫术中的应用效果。方法:回顾性分析2020年6月至2022年6月94例行无充气腋窝入路腔镜单侧甲状腺切除+中央区淋巴结清扫术患者的临床资料,根据是否联合使用术中神经生理监测(IONM)分为IONM组(n=45例,术中联合使用IONM保护RLN)和常规组(n=49例,常规识别保护RLN)。数据统计及分析均采用SPSS 22.0软件完成。围手术期指标、嗓音学指标等计量资料以(x±s)表示,采用独立样本t检验;术后并发症等计数资料以[例(%)]表示,组间比较采用χ^(2)检验。P<0.05为差异有统计学意义。结果:IONM组患者手术时间、RLN暴露时间、中央区淋巴结清扫时间显著短于常规组,术中出血量及术后引流量显著少于常规组,差异均有统计学意义(P<0.05);两组患者术后1个月基频微扰、整幅微扰、标准化噪声能量较术前显著降低,谐噪比显著升高,且IONM组患者各指标均优于常规组(P<0.05);IONM组患者并发症总发生率显著低于常规组(8.9%vs.26.5%,P<0.05)。结论:在无充气腋窝入路腔镜单侧甲状腺切除+中央区淋巴结清扫术中联合应用IONM可快速、准确定位RLN,有效减少手术时间和中央区淋巴结清扫时间,更利于RLN保护,降低RLN损伤程度和并发症发生率,提高手术安全性。Objective:To investigate the effect of recurrent laryngeal nerve(RLN)monitoring in unilateral thyroidectomy and central lymph node dissection without inflatable axillary approach.Methods:Retrospective analysis was performed on the clinical data of 94 patients who underwent unilateral thyroidectomy plus central lymph node dissection without aeration axillary approach from June 2020 to June 2022.The patients were divided into IONM group(n=45 cases)according to whether intraoperative neurophysiological monitoring(IONM)was used in combination with intraoperative neurophysiological monitoring(IONM).Intraoperatively IONM was used to protect recurrent laryngeal nerve(n=49 cases,routine identification of recurrent laryngeal nerve protection)and conventional group.SPSS 22.0 software was used for data statistics and analysis.Measurement data such as perioperative indexes and vocal indexes were expressed as(x±s).Independent sample t test was used for inter-group comparison.Statistical data such as postoperative complications were presented as[example(%)],andχ^(2) test was used for comparison between groups.P<0.05 was considered statistically significant.Results:The operative time,RLN exposure time and central lymph node dissection time in IONM group were significantly shorter than those in conventional group,and the intraoperative blood loss and postoperative drainage volume were significantly lower than those in conventional group,with statistical significance(P<0.05).Fundamental frequency perturbation,whole amplitude perturbation and standardized noise energy of two groups were significantly decreased,harmonic noise ratio was significantly increased,and all indexes in IONM group were better than those in conventional group one month after surgery(P<0.05).The total complication rate in IONM group was significantly lower than that in traditional group(8.9%vs.26.5%,P<0.05).Conclusion:The combined application of IONM in the operation of unilateral thyroidectomy and central lymph node dissection without aeration armpit appro

关 键 词：甲状腺肿瘤 喉返神经 中央区淋巴结 淋巴结切除术 术中神经生理学监测 无充气腋窝入路 

分 类 号：R653[医药卫生—外科学]