甲状腺腺叶切除术患者喉返神经损伤的相关因素及保护策略分析  

Analysis of related factors and protection strategies of recurrent laryngeal nerve injury in patients undergoing thyroid lobectomy

作　　者：陈一东 杨裕志 CHEN Yidong;YANG Yuzhi(the People's Hospital of Daye City,Daye 435100,China)

机构地区：[1]湖北省大冶市人民医院,湖北大冶435100

出　　处：《临床医学研究与实践》2025年第12期30-33,共4页Clinical Research and Practice

摘　　要：目的探讨甲状腺腺叶切除术患者喉返神经损伤的相关因素及保护策略。方法选取2019年1月至2023年9月我院收治的315例行甲状腺腺叶切除术的患者为研究对象。收集患者的基本资料,统计喉返神经损伤情况,分析其相关因素,并制定针对性保护策略。结果315例甲状腺腺叶切除术患者中,共有22例发生喉返神经损伤,损伤率为6.98%,其中19例(6.03%)为暂时性喉返神经损伤,3例(0.95%)为永久性喉返神经损伤。单因素分析结果显示,损伤组和未损伤组的病理类型、手术方式、手术次数、手术时间、术中出血量、被膜解剖方法及是否显露喉返神经比较,差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,恶性病变、全切术、手术时间、术中出血量、非精细化被膜解剖及未显露喉返神经是甲状腺腺叶切除术患者喉返神经损伤的影响因素(P<0.05)。受试者操作特征(ROC)曲线分析结果显示,联合诊断的曲线下面积(AUC)为0.935,95%CI为0.898~0.937,灵敏度为1.000,特异度为0.751;与Az=0.5比较,差异具有统计学意义(P<0.05)。结论恶性病变、全切术、手术时间、术中出血量、非精细化被膜解剖及未显露喉返神经与甲状腺腺叶切除术患者喉返神经损伤相关。临床需采取针对性保护策略,以降低喉返神经损伤的发生率。Objective To investigate the related factors and protection strategies of recurrent laryngeal nerve injury in patients undergoing thyroid lobectomy.Methods A total of 315 patients who underwent thyroid lobectomy in our hospital from January 2019 to September 2023 were selected as the study subjects.The basic data of the patients were collected,the injury of recurrent laryngeal nerve was counted,the related factors were analyzed,and the targeted protection strategies were formulated.Results Among the 315 patients undergoing thyroid lobectomy,22 patients had recurrent laryngeal nerve injury,with an injury rate of 6.98%.Among them,19 cases(6.03%)were temporary recurrent laryngeal nerve injury and 3 cases(0.95%)were permanent recurrent laryngeal nerve injury.The results of univariate analysis showed that there were statistically significant differences in pathological type,surgical method,number of operations,operation time,intraoperative blood loss,capsule anatomy method and whether to expose the recurrent laryngeal nerve between the injury group and the non-injury group(P<0.05).Multivariate Logistic regression analysis results showed that malignant lesions,total resection,operation time,intraoperative blood loss,non-refined capsule anatomy and unexposed recurrent laryngeal nerve were the influencing factors of recurrent laryngeal nerve injury in patients undergoing thyroid lobectomy(P<0.05).The results of receiver operator characteristic(ROC)curve analysis showed that the areas under curve(AUC)of combined diagnosis was 0.935,95%CI was 0.898-0.937,the sensitivity was 1.000,and the specificity was 0.751;compared with Az=0.5,the difference was statistically significant(P<0.05).Conclusion Malignant lesions,total resection,operation time,intraoperative blood loss,non-refined capsular anatomy and unexposed recurrent laryngeal nerve are related to recurrent laryngeal nerve injury in patients undergoing thyroid lobectomy.Targeted protection strategies should be adopted clinically to reduce the incidence of recurrent laryng

关 键 词：甲状腺腺叶切除术 喉返神经损伤 保护策略 

分 类 号：R653[医药卫生—外科学]