甲状腺手术中显露喉返神经以避免喉返神经损伤的临床意义

目的探讨甲状腺手术中显露喉返神经(RLN)对预防RLN损伤的临床意义。方法回顾性分析2006年9月至2011年8月期间我院行甲状腺全切除术和次全切除术1 723例患者的临床资料,其中行显露RLN术式914例,共显露RLN 1 203条;行不显露RLN术式809例,共行1 013侧甲状腺腺叶切除手术。比较术后RLN损伤情况及术后6个月声带恢复情况。结果显露组与不显露组RLN损伤发生率分别为0.91%(11/1 203)和2.07%(21/1 013),2组比较差异有统计学意义(P<0.05)。术后随访6个月,显露组与不显露组分别有0例和13例(61.9%,13/21)永久性RLN损伤,2组比较差异有统计学意义(P<0.01)。结论在甲状腺全切除和次全切除术中,显露并注意保护RLN能最大程度地避免RLN损伤,尤其是永久性RLN损伤。

Clinical Significance on Exposure of Recurrent Laryngeal Nerve in Thyroid Surgery Avoiding Recurrent Laryngeal Nerve Injury

Objective To explore the clinical significance of exposure the recurrent laryngeal nerve(RLN)for preventing the RLN injury in thyroidectomy.Methods The data of 1 723 patients with thyroid diseases undergoing total or subtotal thyroidectomy from September 2006 to August 2011 were retrospectively reviewed.RLN were exposed in 914 cases,1 203 RLNs were exposed(exposed group).RLN were unexposed in 809 cases,1 013 sides were cut(unexposed group).To compare RLN injury rate after operation and recovery of vocal cord in 6 months after operation between the two groups.Results In exposed group,11 cases had RLN injury,the rate of RLN lesion was 0.91%.In unexposed group,21 cases had RLN injury,the rate of RLN lesion was 2.07%.The differences between the two groups had statistical significance(P < 0.05).When six months after operation,0 case and 13 cases in exposed group and unexposed group respectively occurred permanent RLN injury,the differences between the two groups had statistical significance(P<0.01).Conclusion Exposure of RLN in total and subtotal thyroidectomy can significant avoid RLN injury,especially RLN permanent injury.