U 型拉钩降低腔镜辅助甲状腺腺叶切除术的喉返神经牵拉损伤

摘要

Objective To explore the home-made U-shaped retractor ’ s effect on reducing the traction injury of recurrent laryngeal nerve in the video-assistance thyroidectomy . Methods The patients with unilateral and unifocal papillary thyroid microcarcinoma , which were diagnosed by ultrasound preparation and by pathological postoperation , were enrolled .They all underwent the ipdilateral lobectomy , isthmus resection and the clearance of central lymph nodes with video-assistance technology .From January 2013 to June 2014, 79 cases ( control group ) were received conventional method , by which the thyroid lobe was elevated onto the trachea surface.From January 2015 to March 2016, 71 cases (U-shaped group) accepted the procedure which adopted home-made U-shaped retractor to pull the thyroid lobe to carotid artery horizontally .The operations were completed by the same surgeon .There were no significant differences between the two groups in age , gender and lesion size , which is comparable .The incidence rate of hoarseness was compared postoperation . Results Postoperative hoarseness of the U-shaped group occurred in 6 cases (8.5%) and the control group in 17 cases (21.5%), which show a significantly statistical difference (χ2 =4.919, P=0.027).And there was no significant difference in voice recovery time [median:16.5 d (8-31 d) vs.18 d (4-50 d), Z=-0.246, P=0.806]. Conclusion In the video-assisted thyroidectomy , using the U-shaped retractor to pull the thyroid lobe laterally and horizontally will be beneficial to reduce the recurrent laryngeal nerve tension and the incidence of the retract injury .%目的：探讨自制U型拉钩在腔镜辅助甲状腺叶切除术中降低喉返神经牵拉性损伤的作用。方法选择术前超声检查和术后病理确认为单侧单病灶甲状腺微小乳头状癌，行腔镜辅助病侧腺叶＋峡部切除＋病侧中央区淋巴结清扫术，2013年1月～2014年6月79例用常规方法将甲状腺叶向气管前上方牵引（常规组），2015年1月～2016年3月71例使用自制U型拉钩将甲状腺叶向动脉侧水平牵引（U型拉钩组），均为同一外科医生手术。2组年龄、性别、病灶大小无统计学意义（P＞0．05），具有可比性。对比2组声音嘶哑发生率。结果术后声音嘶哑U型拉钩组6例（8．5％），常规组17例（21.5％），2组间比较有统计学差异（χ2＝4．919，P＝0．027）。2组声音恢复时间[中位数16．5 d（8～31 d） vs．18 d（4～50 d）]无统计学意义（Z＝－0．246，P＝0．806）。结论腔镜辅助甲状腺叶切除时，U型拉钩将甲状腺叶向外侧水平牵引有利于降低喉返神经张力，减少喉返神经牵拉性损伤的发生率。