喉返神经“贴膜”保护技术在甲状腺手术中的临床应用

Clinical Application of Recurrent Laryngeal Nerve “Film” Protection Technology in Thyroid Cancer Surgery

摘要: 目的：探讨喉返神经“贴膜”保护技术在甲状腺癌手术中保护喉返神经(Recurrent laryngeal nerve, RLN)的临床效果。方法：回顾性分析2017年1月至2018年12月本院行甲状腺癌手术的115例患者，共有157条喉返神经被解剖并保护。按照手术日期单双号随机分配采取不同的RLN保护方法，其中：常规方法解剖保护了87条喉返神经纳入传统组(65例患者)，喉返神经“贴膜”保护了70条喉返神经纳入新方法组(50例患者)。分析两组术中喉返神经电生理信号的变化以及术后患者发音情况。结果：传统组术中喉返神经电生理信号振幅下降<30%的有60例、振幅下降30%~50%的17例、振幅下降>50%的有10例；新方法组分别有64例、5例、1例；两组差异有统计学意义(P < 0.05)。传统组术后有3例出现声音嘶哑，新方法组没有声音嘶哑的病例，两组差异无统计学意义(P > 0.05)。结论：喉返神经“贴膜”保护技术有利于在甲状腺癌手术中保护喉返神经，提高了手术的安全性。

Abstract: Objective: To investigate the clinical effect of Recurrent laryngeal nerve (RLN) “film” protection technology in thyroid cancer surgery. Methods: The study consisted of 115 patients with thyroid cancer surgery in our hospital from January 2017 to December 2018. And a total of 157 RLN were dissected and protected in the retrospective study. These patients were randomly assigned to take two different methods of RLN protection according to the date of surgery. Among them, conventional methods of anatomical protection of 87 RLN were included in the traditional group. The recurrent laryngeal nerve “film” protected 70 RLN into the new method group. The changes of electrophysiological signals of the RLN and the pronunciation of postoperative patients were analyzed. Results: In the traditional group, there were 60 cases in which the amplitude of the RLN electrophysiological signal decreased by <30%, 17 cases in which RLN signal decreased by 30% - 50%, 10 cases in which RLN signal decreased drop >50%; there were 64 cases, 5 cases, 1 case in the new method group; the difference between the two groups was statistically significant (P < 0.05). In the traditional group, 3 cases had transient hoarseness and the new method group had no hoarseness. Conclusion: The “film” protection technique of the recurrent laryngeal nerve is beneficial to the protection of the recurrent laryngeal nerve in thyroid cancer surgery and has improved the safety of the operation.