显露喉返神经和甲状旁腺下甲状腺癌根治术临床研究

摘要

Objective:To investigate the value of exposing recurrent laryngeal nerve and parathyroid glands in radical thyroidectomy.Method:The clinical data of 182 patients with thyroid cancer undergoing radical thyroidectomy from January 2015 to June 2018 were retrospectively analyzed.According to whether the recurrent laryngeal nerve and parathyroid gland were exposed or not, they were divided into exposed group (n=117) and non-exposed group (n=65), according to the different ways of exposure of recurrent laryngeal nerve, the exposed group were divided into upper approach subgroup (n=17), lower approach subgroup (n=22) and lateral approach subgroup (n=78).The operation related indexes (operation time, intraoperative bleeding volume, postoperative drainage volume) and complications (recurrent laryngeal nerve injury, hypocalcemia) were compared between exposed group and non-exposed group, and the incidence of complications among different subgroups of exposed group was compared.Result:The operation time, intraoperative bleeding volume, postoperative drainage volume in exposed group and non-exposed group were compared, the differences were not statistically significant (P＞0.05).The incidence of recurrent laryngeal nerve injury and hypocalcemia in exposed group were lower than those of nonexposed group (P＜0.05).However, the incidence of recurrent laryngeal nerve injury and hypocalcemia amongdifferent subgroups of exposure group were compared, the differences were not statistically significant (P＞0.05).Conclusion:Radical thyroidectomy with exposure of recurrent laryngeal nerve and parathyroid carcinoma can effectively reduce the risk of recurrent laryngeal nerve and parathyroid gland injury.Exposure of recurrent laryngeal nerve by different approaches can effectively protect the recurrent laryngeal nerve, which can be reasonably selected according to the operation conditions and the experience of the surgeon.%目的:探讨显露喉返神经和甲状旁腺在甲状腺癌根治术中的价值.方法:回顾性分析2015年1月-2018年6月本院182例甲状腺癌根治术患者的临床资料.根据有无显露喉返神经和甲状旁腺分为显露组 (n=117) 和非显露组 (n=65), 显露组再根据术中喉返神经显露入路方式不同分为上入路亚组 (n=17) 、下入路亚组 (n=22) 和侧入路亚组 (n=78) .比较显露组和非显露组的手术相关指标 (手术时间、术中出血量、术后引流量) 及术后并发症情况 (喉返神经损伤、低钙血症), 比较显露组不同亚组间的并发症发生情况.结果:显露组和非显露组手术时间、术中出血量和术后引流量比较, 差异均无统计学意义 (P＞0.05) ;显露组喉返神经损伤和低钙血症发生率均低于非显露组 (P＜0.05), 但显露组不同亚组间喉返神经损伤和低钙血症发生率比较, 差异均无统计学意义 (P＞0.05) .结论:显露喉返神经和甲状旁腺下甲状腺癌根治术可以有效降低喉返神经和甲状旁腺损伤风险, 不同入路方式显露喉返神经均可达到有效保护喉返神经的目的, 可根据术中情况和术者经验合理选择.