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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (06) : 680 -682. doi: 10.3877/cma.j.issn.1674-3946.2021.06.026

论著

甲状腺腺叶切除术两种显露喉返神经方法的临床疗效
梁龙1,†(), 苏民富1, 李嘉根2   
  1. 1. 232000　淮南市朝阳医院头颈外科
    2. 315040　宁波市鄞州人民医院
  • 收稿日期:2020-10-25 出版日期:2021-12-26
  • 通信作者: 梁龙

Clinical analysis of two surgical methods of exposing recurrent laryngeal nerve in thyroidectomy

Long Liang1,†(), Minfu Su1, Jiagen Li2   

  1. 1. Department of Head and neck surgery, Huainan Chaoyang Hospital, Zhejiang 232000, China
    2. Ningbo Yinzhou People’s Hospital, Zhejiang 315040, China
  • Received:2020-10-25 Published:2021-12-26
  • Corresponding author: Long Liang
  • Supported by:
    Zhejiang Provincial Medical and Health Science and Technology Project(2017KY613)
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梁龙, 苏民富, 李嘉根. 甲状腺腺叶切除术两种显露喉返神经方法的临床疗效[J]. 中华普外科手术学杂志(电子版), 2021, 15(06): 680-682.

Long Liang, Minfu Su, Jiagen Li. Clinical analysis of two surgical methods of exposing recurrent laryngeal nerve in thyroidectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(06): 680-682.

目的

比较甲状腺腺叶切除术两种显露喉返神经(RLN)方法的临床效果。

方法

回顾性分析80例甲状腺腺叶切除术患者资料，根据不同术式分为两组，予以精细化被膜解剖结合环甲隙显露RLN (精细组)和常规术甲状腺下动脉显露RLN(常规组)，各40例。采用SPSS 23.0软件进行分析，两组患者术中术后各项指标、治疗前后血清甲状旁腺激素(PTH)和Ca2+等计量资料采用(±s)表示，独立样本t检验；两组患者甲状旁腺、RLN损伤等并发症发生率采用χ2检验比较。P<0.05差异有统计学意义。

结果

两组患者手术时间、术中出血量、疼痛评分、引流量、住院时间差异均无统计学意义(P>0.05)。两组患者术前血清PTH和Ca2+水平差异无统计学意义(P>0.05)，术后常规组PTH和Ca2+均明显低于精细组(P<0.05)。常规组患者术后暂时性甲状旁腺损伤10.0%和RLN损伤发生率7.5%均明显高于精细组(均为0%)P<0.05。

结论

甲状腺腺叶切除术两种显露RLN方法均具有良好的治疗效果，但精细化被膜解剖结合环甲隙显露喉返神经可降低治疗后暂时性RLN损伤和甲状旁腺损伤的发生率。

关键词: 甲状腺切除术, 喉返神经, 喉返神经显露术, 精细化被膜解剖, 环甲隙显露术, 疗效比较研究
Objective

To compare the clinical outcome of two surgical methods of exposing recurrent laryngeal nerve (RLN) in thyroidectomy.

Methods

The clinical data of 80 patients underwent thyroidectomy were analyzed retrospectively. According to the surgical methods, 40 cases were divided into the fine group who received the fine tunica anatomy with exposing the RLN in the cricothyroid space, while 40 cases were divided into the conventional group who received the conventional surgical exposure of RLN under the inferior thyroid artery. Statistical analysis were performed by using SPSS 23.0 software. Measurement data such as intraoperative and postoperative indexes, serum parathyroid hormone (PTH) and Ca2+ level before and after surgery were expressed as (±), and were examined by using t test. The incidence of complications such as parathyroid and RLN injury were examined by using χ2 test. A P value of <0.05 was considered as statistically significant difference.

Results

There were no significant difference between the fine group and the conventional group in terms of the operation time, intraoperative blood loss, pain score, drainage volume and the length of hospitalization (P>0.05). There was no significant difference between the two groups in terms of serum PTH and Ca2+ levels before operation (P>0.05), however the PTH and Ca2+ levels in the conventional group were significantly lower than those in the fine group after operation respectively (P<0.05). Compared with the fine group, the incidence of temporary parathyroid injury of 10% and RLN injury of 7.5% in the conventional group were significantly higher (P<0.05).

Conclusion

Both two surgical methods of exposing RLN in thyroidectomy could achieve good therapeutic effect, but the fine tunica anatomy with exposing the RLN in the cricothyroid space could reduce the incidence of temporary RLN and parathyroid injury after surgery.

Key words: Thyroidectomy, Recurrent laryngeal nerve, Recurrent laryngeal nerve exposure, Refined capsule anatomy, Cricothyroid space exposure, Comparative effectiveness research
表1 80例甲状腺结节/腺瘤患者不同术式两组患者一般临床资料比较[(±s)，例]
组别 例 年龄(岁) 性别 BMI(kg/m2) 病变 结节直径(mm)
男/女 左/右
精细组 40 42.3±11.2 9/31 23.8±5.7 19/21 24±13
常规组 40 42.1±11.3 10/30 23.5±5.6 20/20 25±15
t/χ2值   0.296 0.058 0.287 0.200 0.198
P值   0.716 0.533 0.709 0.967 0.651
表2 80例甲状腺结节/腺瘤患者不同术式两组患者术中术后相关指标比较(±s)
组别 例 手术时间(min) 术中出血量(ml) 疼痛评分
精细组 40 69.5±10.3 18.6±6.2 4.9±1.5
常规组 40 70.2±10.6 18.3±6.1 4.8±1.6
t值   -0.728 0.533 0.578
P值   0.313 0.568 0.592
组别 例 引流量(ml) 住院时间(d)
精细组 40 52.3±10.2 6.2±1.3
常规组 40 51.9±10.3 6.1±1.2
t值   0.673 0.716
P值   0.581 0.618
表3 80例甲状腺结节/腺瘤患者不同术式两组患者术后PTH和血钙指标比较(±s)
组别 例 PTH(pg/ml) Ca2+(mmol/L)
术前 术后 术前 术后
精细组 40 40.3±3.9 38.2±3.5 2.4±0.4 2.2±0.4
常规组 40 40.1±3.8 32.7±3.2 2.3±0.5 1.9±0.3
t值   0.677 12.818 0.699 13.178
P值   0.362 0.026 0.373 0.025
表4 80例甲状腺结节/腺瘤患者不同术式两组患者术后并发症比较[例(%)]
组别 例 甲状旁腺损伤 喉返神经损伤
暂时性 永久性 暂时性 永久性
精细组 40 0 0 0 0
常规组 40 4(10.0%) 0 3(7.5%) 0
χ2值   4.210 - 3.117 -
P值   0.018 - 0.023 -
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