喉返神经显露在甲状腺良性病变手术中的意义

目的 探讨甲状腺良性病变手术中喉返神经(RLN)显露的临床效果.方法 将收治的768例甲状腺良性病变患者按手术序号随机分为3组:(1)选择性显露RLN组(选择组.单号根据患者术中情况显露RLN者),106例,即行腺叶全切、背侧腺体不能保留的腺叶次全切或再次手术者RLN选择显露;(2)选择非显露组(非显露组,单号术中不显露RLN者),278例;(3)常规显露组(常规组,双号术中RLN常规显露),384例.结果 全组RLN损伤率1.04%(8/768),无永久性损伤和双侧损伤.RLN非显露组损伤率0.72%(2/278),选择组0.94%(1/106),常规组1.30%(51384),3组间差异无统计学意义(P＞0.05);非显露组手术时间(78.96±17.60)min,显著短于选择组的(89.05±18.50)min和常规组的(93.44 ±18.90)rain(P＜0.05);非显露组术中出血量(42.73±23.08)mL,显著少于选择组的(56.47 ±24.43)mL和常规组的(62.03±27.46)mL(P＜0.05).结论 在甲状腺良性病变手术中应根据患者情况决定是否显露RLN.

The clinical implication of exposure of recurrent laryngeal nerve during operation for benign thyroid neoplasm

Objective:To explore the clinical effect of exposure of recurrent laryngeal nerve(RLN) during operation in patients with benign thyroid neoplasm. Methods :Seven hundred and sixty-eight patients with benign thyroid neoplasm admitted between July 2005 and June 2008 were randomly divided into three groups according to the operation procedure:(1) For patients with lobectomy or subtotal lobectomy, the dorsum of gland could not be retained or with reoperation,RLN was selectively exposured; (2) 278 cases with non-exposure of RLN; (3) 384 patients had routine exposure of RLN.Results:Of all the cases，the injury rate of RLN was 1.04% (8/768)，no permanent injury or bilateral RLN injury ouarred.The injury rate of RLN in non-exposure groups was 0.72% (2/278), in selective explore groups and routine groups was 0.94%(1/106) and 1.30%(5/384),respectively,but the difference was not significant between the three groups(P>0.05). Operative procedure time was significantly shorter in non-exposure groups than that in selective group and routine group［(78.96±17.60)min vs. (89.05±18.50)min and (93.44±18.90)min,P＜0.05］.The bood loss during operation was significantly less in non-exposure group than that in selective group and routine group［(42.73±23.08)mL vs. (56.47±24.43)mL and (62.03±27.46)mL,P＜0.05］.Conclusions:Exposure and non-exposure of the RLN should be determined by the patient′s condition of benign thyroid neoplasm during operation.