神经探测技术在甲状腺癌二次手术中对喉返神经的保护作用  

Protection Effect of Neural Detection Technique on Recurrent Laryngeal Nerve in Second Surgery for Thyroid Carcinoma

作　　者：张昆[1] 黄华[2] ZHANG Kun;HUANG Hua(Department of Cervical Thyroid Surgery,Nanyang Second People’s Hospital,Nanyang 473000,China;Faculty of Basic Medicine,Nanyang Medical College,Nanyang 473000,China)

机构地区：[1]南阳市第二人民医院颈部甲状腺外科,河南南阳473000 [2]南阳医学高等专科学校基础医学部,河南南阳473000

出　　处：《河南医学研究》2024年第22期4095-4098,共4页Henan Medical Research

基　　金：2023年南阳市科技发展计划项目(23KJGG155)。

摘　　要：目的观察神经探测技术在甲状腺癌(TC)二次手术中对喉返神经(RLN)的保护作用。方法回顾性分析2018年1月至2022年10月南阳市第二人民医院颈部甲状腺外科收治的76例TC复发行二次手术患者的病历资料,根据术中RLN具体保护方法分为A组(42例)和B组(34例)。A组接受术中神经探测技术联合腔镜辅助甲状腺癌根治手术,B组接受常规RLN暴露联合腔镜辅助甲状腺癌根治手术。比较两组手术时间、术中出血量、RLN探查时间、术中RLN识别成功率、术后引流量、住院时间和术后1 d、1周、3个月声带运动异常发生率和术后3个月功能(F)、生理(P)、情感(E)评分等嗓音障碍指数(VHI)及术后3个月喉返神经损伤(RLNI)发生情况。结果A组手术时间、RLN探查时间、术后引流拔除时间短于B组,术中出血量少于B组(P<0.05);A组术中RLN成功识别率为100.00%,高于B组的82.35%(P<0.05);术后1 d和1周,A组声带运动异常发生率低于B组(P<0.05);术后3个月,两组声带运动异常发生率差异无统计学意义(P>0.05);A组术后3个月F评分、P评分和E评分低于B组(P<0.05);A组术后总RLNI发生率为7.14%,低于B组的29.41%(P<0.05)。结论神经探测技术在TC二次手术中可确保RLN功能完整性,降低RLNI发生率,临床效果显著。Objective To explore the protection effect of neural detection technique on recurrent laryngeal nerve(RLN)in second surgery for thyroid carcinoma(TC).Methods A retrospective analysis was performed on the case data of 76 patients with TC recurrence who underwent secondary surgery in Cervical Thyroid Surgery Department of Nanyang Second People’s Hospital between January 2018 and October 2022.According to specific intraoperative protection methods for RLN,they were divided into group A(42 cases)and group B(34 cases).On basis of endoscopic radical resection of TC,group A was given intraoperative neural detection technique,while group B was given routine RLN exposure.The operation time,intraoperative blood loss,exploration time of RLN,success rate of intraoperative RLN identification,postoperative drainage volume,hospitalization time,incidence of paradoxical vocal cord motion at 1 day,1 week and 3 months after surgery,scores of voice handicap index[voice handicap index(VHI),including function(F),physiology(P)and emotion(E)]and occurrence of recurrent laryngeal nerve injury(RLNI)at 3 months after surgery were compared between the two groups.Results The operation time,RLN exploration time and removal time of postoperative drainage in group A were shorter than those in group B,intraoperative blood loss was lesser than those in group B(P<0.05).The success rate of intraoperative RLN identification in group A(100.00%)was higher than that in group B(82.35%)(P<0.05).At 1 day and 1 week after surgery,incidence rates of paradoxical vocal cord motion in group A were lower than those in group B(P<0.05).At 3 months after surgery,there was no significant difference in the incidence of paradoxical vocal cord motion between the two groups.At 3 months after surgery,scores of F,P and E in group A were lower than those in group B(P<0.05).The total incidence of RLNI in group A(7.14%)was significantly lower than that in group B(29.41%)(P<0.05).Conclusion The neural detection technique can ensure the functional integrity of RLN and reduc

关 键 词：神经探测技术 腔镜辅助甲状腺癌根治术 二次手术 喉返神经 保护作用 

分 类 号：R736.1[医药卫生—肿瘤]