甲状腺外科手术操作与手术并发症的相关性

目的 了解甲状腺外科手术操作与手术并发症的相关性,探讨辨认及保护喉返神经、喉上神经外支、甲状旁腺的甲状腺切除术在治疗甲状腺肿物中的作用,以提高甲状腺肿物的手术治愈率,并减少手术并发症。方法 回顾分析甲状腺良性肿瘤或甲状腺癌患者152例临床资料,甲状腺切除采用"精细化被膜解剖"技术,术中辨认及保护喉返神经、喉上神经外支、甲状旁腺。结果 152例患者中,行喉返神经探查262侧,均成功辨认及保护;行喉上神经外支探查231侧,174例成功辨认(75.3%)。原位解剖保护甲状旁腺150例,行甲状旁腺移植术2例。术后发生单侧暂时性喉返神经麻痹1例,在术后3个月内恢复;无喉上神经外支功能障碍。术后发生暂时性甲状旁腺功能低下症13例,术后1周恢复9例, 4周后恢复3例, 5个月后恢复1例。无发生永久性甲状旁腺功能低下症、永久性喉返神经损伤和永久性喉上神经外支损伤病例。结论 术中辨认及保护喉返神经、喉上神经外支、甲状旁腺技术行甲状腺肿物切除术是安全的甲状腺手术操作,有效避免了永久性甲状旁腺功能低下症、喉返神经和喉上神经外支损伤并发症的发生。最大限度地保存了喉功能和甲状旁腺功能,提高了甲状腺肿物的手术治愈率。

Relationship between procedures and complications in thyroid surgery

Objective To investigate the relationship between procedures and complications in thyroid surgery, and the implication of preserving recurrent laryngeal nerves (RLN), the external branches of superior laryngeal nerves (EBSLN), and parathyroid glands in thyroidectomy. Methods Clinical data of 152 patients with benign or malignant thyroid tumors were reviewed. All these patients underwent thyroidectomy with meticulous capsular dissection and peservation of RLN, EBSLN and parathyroid glands. Results 262 RLNs in 152 patients were identified and preserved, while 75.3% EBSLNs(174/231) were identified. In 150 patients, at least one parathyroid were identified and preserved in situ, while 2 patients underwent parathyroid autotransplantation. Transient RLN palsy occurred in 1 case and recovered within three months after the surgery. No EBSLN palsy was found. Transient hypoparathyroidism occurred in 13 cases after the surgery and recovered within one week in 9 cases, four weeks in 3 cases and 5 months in 1 case. Conclusion Identification and preservation of RLN, EBSLN and parathyroid gland in thyroidectomy is recommended in thyroid surgery to effectively avoid the complications, such as injury of RLN/EBSLN and parathyroid glands, which retains the functions of larynx and parathyroid glands and improves cure rate of thyroid tumor.