甲状腺手术喉返神经与甲状旁腺的识别与保护183例分析

目的:探讨甲状腺手术中识别与保护喉返神经与甲状旁腺的技术改进方法及其临床效果.方法:回顾性总结分析183例甲状腺手术病例,以暴露喉返神经方法分组:对照组81例,于甲状腺下动脉下方解剖暴露喉返神经;治疗组102例,以寻找Zuckerkandl结节为主要途径暴露喉返神经.比较两组病人术后喉返神经的损伤、甲状旁腺功能及并发症等方面情况.结果:治疗组102例均临床治愈,术后并发暂时声嘶1(0.9%)例.2例(1.9%)甲状腺次全切除术加颈廓清扫术后出现暂时性甲状旁腺功能低下,32例(31.3%)术后2 d内血钙水平较术前一过性降低.对照组81例有6例(7.4%)损伤喉返神经,4例(4.9%)出现甲状旁腺功能低下.两组差异有统计学意义.结论:甲状腺手术技巧的一系列改进,尤其是对喉返神经和甲状旁腺的识别和保护,可控制术中出血量,减少术后并发症,促进术后康复.

Analysis of 183 Cases on Skills to Identify and Protect Recurrent Laryngeal Nerve and Parathyroid Gland in Thyroid Surgery

Objective To discuss the technical improvement of identification and protection of the recurrent laryngeal nerve and parathyroid glands in thyroid surgeries and clinical effects.Method A retrospective analysis was conducted on 183 patients who have undergone thyroid surgery of them.81 cases during which the recurrent laryngeal nerve was exposed under the inferior thyroid artery were grouped as the control group,102 cases found the way to expose recurrent laryngeal nerve through Zukerkandl tubercle as the treatment group.The occurrence of postoperative complications as recurrent laryngeal nerve injury and hypoparathyroidism in both groups we are observed.Results All 102 patients in the treatment group were clinically cured.One patient(0.9%) was complicated by temporary hoaseness after surgery.Temporarily hypoparathyroidism happened in 2(1.9%) patientes who had subtotal thyroidectomy with cervical lymph node dissection.Thirty twe cases (31.3%) showed a transient asymptomatic decrease of serum calcium.Three(3.7%) out of 81 cases in the control group had an injury of recurrent laryngeal nerve,and 2(2.4%) had hypoparathyroidism.The difference was statistically significant.Conclusion The improvements of thyroid surgery skills particularly for the identification and protection of the recurrent laryngeal nerve and parathyroid glands,were able to minimize intraoperative bleeding,thus reduceing postoperative complications and promoting recovery.