神经探测在甲状腺全切术及中央区淋巴结清扫术中的应用及对喉返神经的保护作用分析  

Application of neural monitoring technology in total thyroidectomy and central lymph node dissection and analysis of protective effect on recurrent laryngeal nerve

作　　者：付瑞敏 赵倩[2] 周克涛 丁勇 甯浪 梁跃[1] FU Rui-min;ZHAO Qian;ZHOU Ke-tao(Department of General Surgery,Guizhou Aerospace Hospital,Zunyi Guizhou 563000,China;Department of Endocrinology,The First People's Hospital of Zunyi,Zunyi Guizhou 563000,China)

机构地区：[1]贵州航天医院普外科,贵州遵义563000 [2]遵义市第一人民医院内分泌科,贵州遵义563000

出　　处：《临床和实验医学杂志》2024年第13期1404-1407,共4页Journal of Clinical and Experimental Medicine

基　　金：贵州省卫生健康委科学技术基金项目(编号:gzwkj2022-342)。

摘　　要：目的探讨神经监测技术在甲状腺全切术及中央区淋巴结清扫术中的应用效果。方法回顾性分析2017年1月至2023年1月在贵州航天医院行甲状腺全切术的100例甲状腺肿瘤患者为研究对象,按照术中是否使用神经探测分为观察组和常规显露组,每组各50例。观察组术中实施喉返神经监测技术,常规显露组术中常规显露喉返神经。记录两组手术指标(手术时间、术中出血量、引流管拔管时间和术后住院时间),比较两组手术前后的简化嗓音障碍指数(VHI-10)评分、声带功能指标、血清甲状旁腺素、钙水平及永久性喉返神经损伤发生率、暂时性喉返神经损伤发生率。结果两组手术时间、术中出血量、引流管拔管时间和术后住院时间比较,差异均无统计学意义(P>0.05)。观察组术后VHI-10评分为(1.18±0.38)分,低于常规显露组[(1.97±0.61)分],差异有统计学意义(P<0.05)。观察组术后谐波噪声比为(25.61±6.07)dB,高于常规显露组[(19.07±4.53)dB],振幅微扰、基频微扰和基频分别为(1.67±0.22)%、(0.20±0.04)%、(132.36±14.23)Hz,均低于常规显露组[(1.67±0.22)%、(0.20±0.04)%、(132.36±14.23)Hz],差异均有统计学意义(P<0.05)。观察组术后血清甲状旁腺素、钙水平分别为(32.46±4.82)μg/L、(2.08±0.48)mmol/L,均高于常规显露组[(18.79±3.05)μg/L、(1.85±0.22)mmol/L],差异均有统计学意义(P<0.05)。观察组暂时性喉返神经损伤发生率为0,低于常规显露组(8.00%),差异有统计学意义(P<0.05),永久性喉返神经损伤发生率比较,差异无统计学意义(P>0.05)。结论神经探测在甲状腺全切术及中央区淋巴结清扫术中的应用效果确切,能够有效改善嗓音及声带功能,保护喉返神经,减少暂时性喉返神经损伤发生,应用价值较高。Objective To investigate the effect of neural monitoring technology in total thyroidectomy and central lymph node dissection.Methods One hundred patients with thyroid tumors who underwent total thyroidectomy in Guizhou Aerospace Hospital from January 2017 to January 2023 were retrospectively analyzed,and divided into the observation group and the conventional exposure group according to whether neural monitoring technology,with 50 cases in each group.The observation group implemented recurrent laryngeal neural monitoring technology during surgery,while the conventional exposure group underwent intraoperative routine exposure of the recurrent laryngeal nerve.The surgical indexes(operation time,intraoperative blood loss,drainage tube removal time,and postoperative hospital stay)of the two groups were recorded,and the simplified Voice Handicap Index(VHI-10)scores,vocal fold function indexes,serum parathyroid hormone,calcium levels,and the incidence of permanent laryngeal recurrent nerve injury and temporary laryngeal recurrent nerve injury were compared before and after the surgery in both groups.Results There were no statistically significant differences between the two groups in terms of operation time,intraoperative blood loss,drainage tube removal time,and postoperative hospital stay(P>0.05).The VHI-10 score of the observation group after surgery was(1.18±0.38)points,which was lower than that of the conventional exposure group[(1.97±0.61)points],and the difference was statistically significant(P<0.05).The harmonic noise ratio of the observation group after surgery was(25.61±6.07)dB,which was higher than that of the conventional exposure group[(19.07±4.53)dB],the amplitude perturbation,fundamental frequency perturbation,and fundamental frequency perturbation were(1.67±0.22)%,(0.20±0.04)%,and(132.36±14.23)Hz,respectively,which were all lower than those of the conventional exposure group[(1.67±0.22)%,(0.20±0.04)%,and(132.36±14.23)Hz],and the differences were statistically significant(P<0.05).The levels of

关 键 词：甲状腺肿瘤 甲状腺全切术 中央区淋巴结清扫术 神经探测 

分 类 号：R736.1[医药卫生—肿瘤]