甲状腺手术中喉返神经的显露与保护分析及个性化治疗

目的:通过在甲状腺手术中采取主动解剖显露喉返神经的保护措施及个性化治疗,达到减少和预防喉返神经损伤的目的。方法:选择甲状腺手术患者200例,其中100例采取主动解剖显露喉返神经的保护措施,另100例行常规手术,对比两种术式治疗效果。结果:观察组患者中有1例发生单侧喉返神经损伤,且在术后3个月内声嘶消失,术中喉返神经损伤率为1%;对照组术后有8例发生声嘶,术中喉返神经损伤率为8%,观察组与对照组术中喉返神经损伤经统计学检验有显著差异。结论:甲状腺手术中采取主动解剖显露喉返神经的措施能大大降低术中对喉返神经的损伤,术中采取个体化的方案对降低喉返神经损伤率尤为重要,同时要避免将神经周围完全分离,这样既可减少神经误伤,又可减少术后神经因局部水肿或缺血导致声嘶甚至呼吸困难的问题。

The analysis of revealing and protecting the recurrent laryngeal nerve in thyroid surgery and the personalized treatment

Objective:To reduce and prevent the recurrent laryngeal nerve injury through the method with initiatively revealing the recurrent laryngeal nerve in thyroid surgery.Methods: The 200 patients were randomly divided into two groups,of which 100 cases was took the initiative to reveal the anatomy of the recurrent laryngeal nerve,and the other 100 cases was to conventional surgery,to compare the effect of the two surgical treatment.Results: As for all objects in the observation group,there was 1 patient with occurring unilateral recurrent laryngeal nerve injury and hoarseness disappeared in the next 3 months,and the rate of the recurrent laryngeal nerve injury was 1%;In control group,8 patients suffered from hoarseness after the thyroid surgery,the rate of the recurrent laryngeal nerve injury was 8%.There was significant differences between the observation group and control group.Conclusion:The measures,which revealed recurrent laryngeal nerve initiatively in thyroid surgery,can greatly reduce the rate of the intraoperative recurrent laryngeal nerve injury.It is particularly important to take an individualized program to reduce the rate of recurrent laryngeal nerve injury,however,meanwhile,to avoid completely dissecting the nerve.In this way,we can not only reduce the nerve injury but curb postoperative hoarseness or difficulty breathing problem caused by ischemia or local edema.