精细解剖喉返神经对甲状腺手术的临床意义

目的 探讨精细解剖显露喉返神经对甲状腺手术的临床意义.方法 将2010年1月至2012年1月期间在汕头大学医学院第二附属医院普外科行甲状腺手术患者148例完全随机分成试验组105例、对照组43例.试验组即术中精细解剖显露喉返神经,对照组未解剖显露喉返神经.比较2组患者的性别、年龄、肿块性质、手术方式以及喉返神经损伤等情况.结果 2组患者的性别、年龄、肿块性质、手术方式等差异均无统计学意义(均P ＞0.05)；试验组出现喉返神经损伤1例,总损伤率0.95％(1/105)；对照组出现喉返神经损伤3例,总损伤率6.97％(3/43).2组神经损伤率比较,差异有统计学意义(P＜0.05).结论 精细解剖显露喉返神经对甲状腺手术而言,能有效避免喉返神经的损伤,即使误伤,也能在术中及时发现,从而采取相应措施,避免喉返神经永久性损伤.

The clinical value of exposure of recurrent laryngeal nerve by precise neurotomy In thyroid surgery

Objective To investigate the clinical value of precise neurotomy of recurrent laryngeal nerve in thyroid surgery. Methods One hundred and forty-eight patients with thyroidectomy were divided into two groups, 105 patients in the experiment group and 43 patients in the control group. In the experiment group, recurrent laryn- geal nerve was exposed by precise neurotomy. In the control group, the above-mentioned nerve was not exposed. The clinical value was determined by comparing the general situation of patients, such as age, sex, mass pathotype, the way of operation and the incidences of injury to the nerve between the two groups respectively. Results There was no statistical difference between the two groups in the above-mentioned factors （P 〉 0.05 ）. However, there was 1 case of exposed recurrent laryngeal nerve in thyroidectomy with post-operative hoarseness and 3 cases without ex- posed recurrent laryngeal nerve in thyroideetomy. The total incidence of injury to the nerve between the two groups was 0.95% （ 1/105 ） and 6.97% （3/43）, respectively （P 〈 0.05 ） . Conclusions Exposure of recurrent laryn- geal nerve by precise neurotomy in thyroid surgery can effectively avoid the damage of the recurrent laryngeal nerve. Moreover appropriate measures should be taken to avoid permanent damage of recurrent laryngeal nerve.