切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2022, Vol. 16 ›› Issue (03) : 331 -334. doi: 10.3877/cma.j.issn.1674-3946.2022.03.026

论著

喉上神经外支监测技术在甲状腺上极肿瘤手术中的应用
王科1, 张海鹏1, 徐大道1, 赵琳1,()   
  1. 1. 710077 西安,西安医学院第一附属医院耳鼻咽喉头颈外科
  • 收稿日期:2021-04-13 出版日期:2022-04-26
  • 通信作者: 赵琳

Application of monitoring technique of external branch of superior laryngeal nerve in operation of superior pole thyroid tumor

Ke Wang1, Haipeng Zhang1, Dadao Xu1, Lin Zhao1,()   

  1. 1. Department of Otolaryngology Head and Neck Surgery,First Affiliated Hospital of Xi’an Medical College,Xi’an Shanxi Province 710077,China
  • Received:2021-04-13 Published:2022-04-26
  • Corresponding author: Lin Zhao
  • Supported by:
    Shanxi Provincial Key Research and Development Program(2020SF-039)
引用本文:

王科, 张海鹏, 徐大道, 赵琳. 喉上神经外支监测技术在甲状腺上极肿瘤手术中的应用[J/OL]. 中华普外科手术学杂志(电子版), 2022, 16(03): 331-334.

Ke Wang, Haipeng Zhang, Dadao Xu, Lin Zhao. Application of monitoring technique of external branch of superior laryngeal nerve in operation of superior pole thyroid tumor[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(03): 331-334.

目的

探讨喉上神经外支(EBSLN)监测技术在甲状腺肿瘤手术中的应用效果,确定喉上神经的解剖分型。

方法

前瞻性选取2018年11月至2020年11月收治的132例甲状腺肿瘤患者资料,按随机数字表法分为研究组(术中行EBSLN监测,n=66例)和对照组(术中不采用EBSLN监测,n=66例)。采用软件SPSS 19.0进行统计学分析。围手术期相关指标、术后嗓音障碍指数量表(VHI-10)评分等计量资料以(

xˉ
±s)表示,独立样本t检验;EBSLN损伤发生率等计数资料以[n(%)]表示,采用χ2检验。以P<0.05表示差异有统计学意义。

结果

研究组患者EBSLN损伤发生率、引流拔管时间及住院时间均明显低于对照组(P<0.05),术后第1天引流量均少于对照组(P<0.05);研究组患者术后1个月VIH-10评分均优于对照组(P<0.05)。研究组处理EBSLN 113条,肉眼直视识别率低于术中EBSLN监测识别率(P<0.05);肿瘤位于上极时EBSLN肉眼识别率显著低于EBSLN监测识别率(P<0.05);EBSLN与甲状腺上动脉的交叉点距甲状腺上极>1 cm者共58条(51.3%),<1 cm者共55条(48.7%);依据EBSLN与咽下缩肌的关系分为:型27条、型51条、型11条、型24条。

结论

EBSLN监测技术在甲状腺上极手术中可提高术中EBSLN的识别率,可对喉上神经外支的走行及变异进行定位,指导术中减少神经损伤发生的风险。

Objective

To investigate the application of EBSLN monitoring technique in thyroid tumor surgery,and to determine the anatomical classification of the superior laryngeal nerve.

Methods

Data of 132 patients with thyroid tumor admitted from November 2018 to November 2020 were prospectively selected and randomly divided into study group(intraoperative EBSLN monitoring,n=66 cases)and control group(intraoperative EBSLN monitoring,n=66 cases). SPSS 19.0 was used for statistical analysis. Perioperative related indicators,postoperative voice disorder Index scale(VHI-10)score and other measurement data were represented by(

xˉ
±s),independent t test;The incidence of EBSLN injury was expressed as[n(%)],and 2 test was used. P<0.05 indicated that the difference was statistically significant.

Results

The incidence of EBSLN injury,drainage extubation time and hospital stay in the study group were significantly lower than those in the control group(P<0.05),and the drainage volume on the first postoperative day was significantly lower than that in the control group(P<0.05). The VHI-10 score of the study group was better than that of the control group 1 month after surgery(P<0.05).In the study group,113 EBSLN cases were treated,and the visual recognition rate was lower than that of intraoperative EBSLN monitoring(P<0.05). The gross recognition rate of EBSLN was significantly lower than that of EBSLN monitoring when the tumor was located in the upper pole(P<0.05). The crossing point between EBSLN and superior thyroid artery was more than 1cm away from the superior pole of thyroid in 58 cases(51.3%)and less than 1cm in 55 cases(48.7%). According to the relationship between EBSLN and hypopharyngeal contractor,there were 27 cases of type ,51 cases of type ,11 cases of type and 24 cases of type .

Conclusion

EBSLN monitoring technology can improve the intraoperative EBSLN recognition rate in the thyroid superior pole operation,and can locate the course and variation of the external branch of the superior laryngeal nerve,so as to guide the intraoperative reduction of the risk of nerve injury.

表1 132例甲状腺肿瘤术中行EBSLN监测与否两组患者一般资料比较[(
xˉ
±s),例]
表2 132例甲状腺肿瘤术中行EBSLN监测与否患者围手术期相关指标比较[(
xˉ
±s),例]
表3 132例甲状腺肿瘤术中行EBSLN监测与否两组患者VIH-10评分比较(
xˉ
±s
表4 甲状腺肿瘤根治术中处理113条EBSLN不同识别方式识别结果比较[条(%)]
表5 66例甲状腺肿瘤根治术患者113条EBSLN的分型与特征[条(%)]
图4 喉上神经外支
[1]
EI-Gaabary IMCh MBBEI-Sherief MM,et al. Assessment of nerve stimulation during thyroidectomy for identification of the external branch of superior laryngeal nerve[J]. The Egyptian Journal of Surgery202039(4):972-978.
[2]
Zhou BZhai YHei H,et al. The strap intermuscular approach can significantly increase the exposure rate of the external branch of the superior laryngeal nerve during thyroid surgery[J]. Surg Oncol202035:56-61.
[3]
何高飞,章德广,高力,等. 改良Miccoli腔镜辅助技术结合神经探测技术解剖保护喉上神经外支[J]. 中华普通外科杂志201934(3):255-256.
[4]
张立功,钱军,李志祥,等. 不同手术入路显露甲状腺喉上神经对比研究[J]. 中国实用外科杂志201939(3):240-242.
[5]
Aleksova LAli MMChakarov DI,et al. Identification of the External Branch of the Superior Laryngeal Nerve during Thyroid Surgery[J]. Folia Med201860(1):154-157.
[6]
Dessie MA. Variations of the origin of superior thyroid artery and its relationship with the external branch of superior laryngeal nerve[J]. PLoS ONE201813(5):e0197075.
[7]
Cheruiyot IKipkorir VHenry BM,et al. Surgical anatomy of the external branch of the superior laryngeal nerve:a systematic review and meta-analysis[J]. Langenbecks Arch Surg2018403(7):811-823.
[8]
李红强,陈亚丽,赵杰,等. 神经监测技术在开放甲状腺术中保护喉上神经外支的应用[J]. 中华内分泌外科杂志201812(1):10-13.
[9]
薛军军,郭宏义,宁亚文,等. 术中神经监测技术在甲状腺手术中的临床应用[J]. 中国现代医学杂志202030(3):87-92.
[10]
马泓智,房居高,侯丽珍,等. 甲状腺肿瘤术中喉上神经外支解剖观察及功能保护[J]. 国际耳鼻咽喉头颈外科杂志202044(1):1-5.
[11]
王征,张浩,李伟汉,等. 术中持续与间断神经监测技术在腔镜辅助甲状腺手术中的对比研究[J/CD]. 中华普外科手术学杂志(电子版)202014(2):170-173.
[12]
Cheruiyot I,Kipkorir,Henry BM,et al. Surgical anatomy of the external branch of the superior laryngeal Nerve:a systematic review and meta-analysis[J]. Langenbecks Arch Surg2018403(7):811-823.
[13]
王亚希,菅雁兵,王冰,等. 喉上神经外支监测技术在甲状腺上极肿瘤手术中的应用探讨[J]. 中华内分泌外科杂志201913(1):5-8.
[14]
丁金旺,张卧,王可敬. 喉上神经外支解剖分型及其辨识保护技术在甲状腺手术中的应用进展[J]. 国际耳鼻咽喉头颈外科杂志202044(1):37-41.
[1] 孙莲, 马红萍, 吴文英. 局部进展期甲状腺癌患者外科处理[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 112-114.
[2] 麻紫月, 王贞文, 张强, 赵代伟, 张翊伦. 右侧喉不返神经1例报告[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 115-116.
[3] 顾雯, 凌守鑫, 唐海利, 甘雪梅. 两种不同手术入路在甲状腺乳头状癌患者开放性根治性术中的应用比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 687-690.
[4] 田文. 甲状腺癌功能性根治颈淋巴结清扫术[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 482-482.
[5] 王宇, 徐芳泉, 周旋, 姚晓峰, 李强. 不断提高分化型甲状腺癌根治性切除规范化[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 473-476.
[6] 孙辉, 李长霖. 分化型甲状腺癌根治性切除术中的关键考量与策略[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 477-481.
[7] 高一飞, 刘根祥, 孙长华, 周广军. 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[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 483-486.
[8] 李云龙, 夏旭良, 江志强, 刘伟, 刘凯, 唐立, 刘昊中, 张思远. 三种方法治疗分化型甲状腺癌的临床疗效[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 487-489.
[9] 韩婧, 郝少龙, 康骅. 北京市单中心甲状腺癌患者临床特征的回顾分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 490-493.
[10] 宋红霞, 吴玩呈. 内镜下甲状腺手术切口入路发展的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 470-472.
[11] 何羽. 腔镜微创手术治疗分化型甲状腺癌的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 456-458.
[12] 游涛建, 任林, 马宇. cT1-2N0期PTMC经口腔前庭入路腔镜甲状腺切除术后引流与否的可行性研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(03): 311-314.
[13] 吴波, 郑永明, 杜世强. SPECT/CT及血清sTg水平预测甲状腺癌术后131I治疗患者淋巴结转移风险的价值分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(02): 212-216.
[14] 徐成, 王璐璐, 王少华. 洗脱液甲状腺球蛋白在甲状腺乳头状癌转移淋巴结中的应用[J/OL]. 中华普外科手术学杂志(电子版), 2023, 17(06): 701-704.
[15] 刘通, 李菲, 朱莹, 王蓓. 剪切波弹性成像对甲状腺癌术后放射性碘治疗损伤唾液腺腺体的评估[J/OL]. 中华诊断学电子杂志, 2024, 12(02): 80-84.
阅读次数
全文


摘要