甲状腺手术暴露与非暴露术式对喉返神经的保护作用比较

 目的 探讨甲状腺手术暴露与非暴露术式对喉返神经的保护作用。方法 采用前瞻性队列研究的方法, 根据是否暴露将我科行甲状腺手术327例分为喉返神经暴露组与非暴露组。主要终点事件为喉返神经损伤的发生率, 随访至术后6个月。结果 完整随访307例。喉返神经损伤发生率3.2%。按组分析, 喉返神经暴露组, 喉返神经损伤率3.0%, 其中永久性损伤1例(0.61%), 暂时性损伤4例(2.42%);喉返神经非暴露组, 喉返神经损伤率3.5%, 其中永久性损伤1例(0.70%), 暂时性损伤4例(2.82%)。两组比较, 喉返神经损伤发生率差异无统计学意义。结论 常规暴露喉返神经并不增加损伤机会, 鉴于腺叶切除在甲状腺手术中的作用越来越重要, 应考虑常规显露喉返神经。

Exposing recurrent laryngeal nerve during thyroidectomy to reduce incidence of injury(a perspective cohort study)

Objective To determine the protective effect of exposing the recurrent laryngeal nerve(RLN) during thyroidectomy. Metholds This is a perspective cohort study. The patients, admitted between January 2007 and December 2010, were divided into two groups according to whether exposed the RLN. The main end point was the incidence of RLN injury within 6 months. Results 327 patients were included in this study, with the follow-up more than 6 months in 307 patients. The incidence of RLN injury was 3.2%. The incidence of RLN injury in exposing and non-exposing groups was 3.0%(temporary 2.42%, permanent 0.61%) and 3.5%( temporary 2.82%, permanent 0.70%), respectively. There was no significant difference between these two groups. Conclusions RLN exposure leads no increase in the incidence of RLN injury. Exposure of the RLN should be routinely done in the era of lobectomy.