216例甲状腺癌手术不同术式对喉返神经影响

目的评估甲状腺癌手术中不同术式对减少喉返神经（RLN）损伤的意义。方法回顾性分析我院2007年至2008年216例甲状腺癌手术治疗资料，按手术方式不同分3组：解剖RLN甲状腺全切除组（解剖组）、精细化被膜解剖甲状腺全切除组（精细化被膜解剖组）和保留甲状腺后背膜甲状腺次全切除组（保留后背膜组）。结果解剖组83侧，1例出现永久性损伤，4例暂时性损伤；精细化被膜解剖组187侧，8例永久性损伤，1例暂时性损伤；保留后背膜组153侧，无永久性及暂时性RLN损伤。永久性喉返神经损伤差异，解剖组与精细化被膜解剖组均有统计学意义（P〈0．05），解剖组与保留后被膜组无统计学意义（P〉0．05）。结论甲状腺全切术解剖喉返神经能减少喉返神经永久性损伤；甲状腺次全切除术没必要解剖喉返神经，保留甲状腺后被膜是一种安全的术式。

Influence of different operations of thyroidectomy on recurrent laryngeal nerve-analysis of 216 gases

Objective To investigate recurrent laryngeal nerve(RLN)injury in different thyroidectomy.Methods Two hundred and twenty-six thyroid carcinoma patients were divided three groups:group A was RLN dissected and total lobectomy group,group B was meticulous capsular dissection with total lobectomy group.group G was subtotal lobectomy plus posterior capsular reserved group.The rate of RLN iniury was compared in three groups.Results One case suffered from permanent RLN injury in group A.Eight cases suffered from permanent RLN injury in group B.There was significant difference between the two groups(P<0.05).No case suffered from RLN injury in group C.There was no difference between group B and C(P>0.05).Conclusions The dissection of RLN decreases RLN permanent injury in total lobectomy.It is not necessary to dissect the RLN in subtotal lobectomy,it is a safe appraoch to reserve posterior capsular.