早期分化型甲状腺癌腔镜辅助手术中喉返神经监测的应用
| 作者: |
1王晖,
2胡丽萍,
1史永照,
1李学庆,
1高斌,
1程志俭
1 复旦大学附属上海市第五人民医院 普通外科，上海 200240 2 复旦大学附属闵行医院 普通外科，上海 200240 |
| 通讯: |
李学庆
Email: xueqli@163.com |
| DOI: | 10.3978/.10.3978/j.issn.1005-6947.2015.11.003 |
摘要
目的：探讨喉返神经监测在腔镜辅助手术治疗早期分化型甲状腺癌术的应用效果。方法：回顾分析2012 年6 月—2015 年1 月在腔镜辅助下手术治疗180 例早期分化型甲状腺癌患者临床资料，其中喉返神经监测90 例（监测组），非喉返神经监测90 例（非监测组）。比较两组相关指标及术后暂时性及永久性喉返神经损伤发生率。结果： 监测组平均手术时间、术中出血量、术后引流量明显少于非监测组[（90.2±20.2）min vs.（100.2±26.9）min；（16.3±13.2）mL vs. （24.4±9.8）mL；（25.5±8.5）mL vs. （29.7±5.6）mL，均P<0.05]；淋巴结清扫数量、术后住院时间两组间无统计学差异[（5.1±1.9）个vs. （4.9±1.2）个；（3.8±2.5）d vs. （3.9±2.7）d，均P>0.05]。术后随访12 周，监测组暂时性神经损伤发生率7.4%（8/105），非监测组19.0%（18/95），差异有统计学意义（P<0.05）；监测组永久性神经损伤发生率1.0%（1/105），非监测组3.2%（3/95），差异无统计学意义（P>0.05）。结论：腔镜辅助下早期分化型甲状腺癌手术中应用喉返神经监测技术可有效减少暂时性神经损伤发生率，缩短手术时间，减少术中出血量。
关键词：
甲状腺肿瘤/ 外科学
喉返神经损伤
内窥镜
Application of intraoperative neuromonitoring of recurrent laryngeal nerve in endoscopy-assisted thyroidectomy for early differentiated thyroid carcinoma
CorrespondingAuthor:LI Xueqing Email: xueqli@163.com
Abstract
Objective: To investigate the effect of intraoperative neuromonitoring (IOM) of the recurrent laryngeal nerve recurrent laryngeal nerve (RLN) in endoscopy-assisted thyroidectomy for early differentiated thyroid carcinoma (DTC). Methods: The clinical data of 180 patients with early DTC undergoing endoscopy-assisted thyroidectomy from June 2012 to January 2015 were retrospectively analyzed. Of the patients, 90 cases received IOM of RLN (monitoring group), and the other 80 cases did not receive IOM of RLN (non-monitoring group). The relevant surgical variables and the incidence of transient and permanent RLN injury between the two groups were compared. Results: In monitoring group compared with non-monitoring group, the mean operative time, intraoperative blood loss, postoperative drainage volume were significantly reduced [(90.2±20.2) min vs. (100.2±26.9) min; (16.3±13.2) mL vs. (24.4±9.8) mL; (25.5±8.5) mL vs. (29.7±5.6) mL, all P<0.05]; the number of removed lymph nodes and length of hospital stay showed no significant difference [(5.1±1.9) vs. (4.9±1.2); (3.8±2.5) d vs. (3.9±2.7) d, both P>0.05]. During a 12-week follow-up, the incidence of temporary RLN injury was 7.4% (8/105) in monitoring group and 19.0% (18/95) in non-monitoring group, and the difference had statistical significance (P<0.05), while incidence of permanent RLN damage was 1.0% (1/105) in monitoring group and 3.2% (3/95) in non-monitoring group which had no significant difference (P>0.05). Conclusion: Using IOM of RLN in endoscopy-assisted thyroidectomy for early DTC can effectively reduce the incidence of transient RLN injury, shorten the operative time and reduce intraoperative blood loss.
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