甲状腺癌根治术中发生喉返神经损伤的因素分析

目的对甲状腺癌根治术中发生喉返神经损伤的因素进行调查并分析。方法回顾性分析2010年7月至2015年7月725例甲状腺癌根治术患者临床资料,考察术中发生喉返神经损伤的危险因素。采用SPSS19.0软件分析,性别、麻醉方式、病变性质、是否显露喉返神经、手术次数、手术范围、喉返神经分离方式及操作原则等计数资料的单因素分析采用χ~2检验,多因素分析采用Logistic分析,相关性分析采用Logistic回归分析。P0.05为差异具有统计学意义。结果 725例手术中发生喉返神经损伤28例,发生率3.86%。单因素分析显示多次手术、广泛性手术、术中不显露及非精细化被膜解剖患者喉返神经损伤发生率显著升高(χ~2=7.425、4.657、5.091、4.591,P0.05)。多因素分析显示,非精细化被膜解剖、多次手术、广泛性手术是喉返神经损伤发生的独立危险因素。结论精细化被膜解剖和缩小手术范围有助于降低喉返神经损伤发生率,多次手术术中操作应当更加注意避免损伤。

Risk factors of recurrent laryngeal nerve injury during radical resection of thyroid carcinoma

Objective To investigate the risk factors of recurrent laryngeal nerve injury during radical resection of thyroid carcinoma . Methods The clinical data of 725 patients with thyroid carcinoma treated from June 2010 to June 2015 were retrospectively analyzed , and the risk factors of recurrent laryngeal nerve injury were investigated .SPSS 19.0 software was used for data analysis .The data on sex, anesthesia, pathological results of the lesions , exposure of the recurrent laryngeal nerve , number of operations , scope of operation, dissection of RLN and principles of operation were examined by the Chi-square test.Multiple factor analysis was made using logistic analysis , and correlation analysis by logistic regression .P<0.05 was considered statistically significant . Results In 725 patients, 28 (3.86%) had recurrent laryngeal nerve injury.Single factor analysis showed that the incidence of RLN injury was higher in patients undergoing repeated operation, extensive surgery, non-fine membrane dissection and non-intraoperative exposure of RLN (χ2 =7.425、4.657、5.091、4.591 respectively, P<0.05).Multiple factor analysis showed that non-fine membrane dissection , repeated operation , and extensive surgery were the independent risk factors of RLN injury. Conclusion Fine membrane dissection and appropriate operative range could help to reduce the incidence of RLN injury , and more attention should be paid to avoid RLN injury in repeated operation .