喉返神经“最下径路、隔热保护”在甲状腺癌手术中的应用

目的 探讨颈段喉返神经(recurrent laryngeal nerve，RLN)“最下径路寻找、顺行解剖、隔热保护”的新方法在甲状腺癌手术中应用的临床效果，为降低手术中RLN损伤提供新的思路。 方法 回顾性分析2018年2月—2019年1月中国科学技术大学附属第一医院普外科手术的右侧甲状腺癌患者53例，行右侧甲状腺切除加右侧中央区淋巴结清扫，其中:传统方法24例，新方法29例。统计分析2组术中喉返神经电生理信号的变化以及术后患者发音情况、术后并发低钙血症的情况、颈部中央区淋巴结转移数目等。 结果 传统组术中电生理信号振幅下降>50%的有6例，新方法组有1例，2组差异有统计学意义(P＜0.05)；2组患者术后手脚麻木等低钙血症表现，传统组有3例、新方法组4例，2组差异无统计学意义(P＞0.05)；传统组有中央区淋巴结转移的患者14例(58.3%)，新方法组有18例(62.1%)，2组差异无统计学意义(P＞0.05)；2组中央区颈部淋巴结清扫数量分别为(3.1±1.8)枚和(5.0±2.4)枚，差异有统计学意义(P＜0.05)。 结论 喉返神经“最下径路、隔热保护”技术降低了甲状腺手术中损伤RLN的风险，有助于在甲状腺癌手术中保护RLN，提高了甲状腺手术的安全性。 

Application of inferior approach and thermal insulation of the recurrent laryngeal nerve in thyroid cancer surgery

Objective To investigate the safety and feasibility of the most inferior approach, anterograde dissection and thermal insulation protection of the cervical recurrent laryngeal nerve (RLN) in thyroid cancer surgery. Methods A retrospective analysis was performed on 53 patients with thyroid cancer who underwent right thyroidectomy and lymph node dissection in the right central region from February 2018 to January 2019. There were 24 cases with traditional method and 29 cases with new method. The changes of electrophysiological signals of the recurrent laryngeal nerve, postoperative pronunciation, incidence of postoperative hypocalcemia and the number of lymph node metastases in the central region of the neck were statistically analyzed. Results In the traditional group, there were 6 cases in which the amplitude of the RLN electrophysiological signal decreased by ＞50%, and 1 cases in the new method group, there were statistically significant differences between the two groups (P＜0.05). There were 3 cases hypocalcaemia after the surgery in the traditional group and 4 cases in the new method group, there were no statistically significant differences between the two groups (P＞0.05). There were 14 (58.3%) cases lymph nodes in the central region of the traditional group, and 18 (62.1%) cases in the new method group, there were no statistically significant differences between the two groups (P＞0.05). There were 3.1±1.8 lymph node dissections in the central zone in the traditional group and 5.0±2.4 in the new method group, the difference between the two groups was statistically significant (P＜0.05). Conclusion The technique of the most inferior approach and thermal insulation protection of recurrent laryngeal nerve is benefit to protect the RLN and improve the safety in thyroid cancer surgery.