解剖暴露喉返神经术在甲状腺叶切除术中的临床意义
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摘要
目的探讨解剖暴露喉返神经术在甲状腺叶切除术中的临床意义。方法将2010年3月至2013年3月重庆市长寿区人民医院收治的200例甲状腺病变患者依据随机数字表法分为对照组和观察组,各100例。对照组术中不暴露喉返神经,观察组术中解剖暴露喉返神经,对两组患者进行为期6个月的随访。对比两组患者的首日引流量、术中出血量、手术时间、手术皮瓣的面积、甲状旁腺功能、胶质细胞源性神经营养因子(GDNF)水平。结果观察组甲状旁腺受损率低于对照组[0.0%(0/100)比5.0%(5/100)],观察组随访3个月和半年的喉返神经损伤率低于对照组[0.0%(0/100)比3.0%(3/100),8.0%(8/100)比12.0%(12/100)],差异有统计学意义(P<0.05)。观察组术后皮瓣面积、手术时间、术中出血量、住院时间、术后首日引流量均少于对照组[(123±11)cm2比(146±27)cm2,(64±7)min比(68±11)min,(8±3)m L比(56±13)m L,(8.4±1.3)d比(14.5±1.9)d,(130±5)m L比(180±7)m L],差异有统计学意义(P<0.01)。术前两组患者血清GDNF水平差异无统计学意义(P>0.05),术后出现喉返神经损伤患者GDNF水平下降,随访至3个月时观察组患者GDNF水平显著高于对照组(P<0.05),随访6个月后,观察组GDNF值基本恢复至术前水平,但对照组GDNF明显较低(P<0.05)。结论甲状腺术中解剖暴露喉返神经有利于保护喉返神经,GDNF可能成为甲状腺叶切除术后检测喉返神经功能的生物学指标,有望成为治疗喉返神经损伤的靶方向。
Objective To discuss the clinical significance of the surgical exposure of recurrent laryngeal nerve in thyroid lobectomy. Methods Total of 200 patients with thyroid disease admitted to Changshou District People's Hospital from Mar. 2010 to Mar. 2013 were included and divided into a control group of 100 cases,and an observation group of 100 cases according to the random number table method: in the control group,there was no recurrent laryngeal nerve exposure procedure during the surgery; in the observation group there was recurrent laryngeal nerve exposure procedure during the surgery,then a six-month follow-up was done for both groups. The first day drainage amount,intraoperative blood loss,operative time,surgical flap area,parathyroid function,glial cell line-derived neurotrophic factor( GDNF) levels of the two groups were compared. Results Parathyroid damage rate in the observation group was lower than the control group[0. 0%( 0 /100) vs 5. 0%( 5 /100) ],the three months and six months recurrent laryngeal nerve injury rate of the observation group were lower than the control group[0. 0%( 0 /100) vs 3. 0%( 3 /100),8. 0%( 8 /100) vs 12. 0%( 12 /100) ],the differences weres statistically significant( P < 0. 05). Flaps area,operative time,blood loss,hospital stay,postoperative drainage volume on the first day of the observation group were less than the control group[( 123 ± 11) cm2vs( 146 ± 27) cm2,( 64 ± 7) min vs( 68 ± 11) min,( 8 ±3) m L vs( 56 ± 13) m L,( 8. 4 ± 1. 3) d vs( 14. 5 ± 1. 9) d,( 130 ± 5) m L vs( 180 ± 7) m L],the differences were statistically significant( P < 0. 01). The preoperative serum GDNF levels of the two were similar( P > 0. 05),while the postoperative GDNF level of patients with recurrent laryngeal nerve injury was decreased,by three months after surgery,GDNF level of the observation group was significantly higher than the control group( P < 0. 05),to six months after surgery,GDNF level of the observation group returned to preoperative level,but GDNF level of the control group was significantly lower( P < 0. 05). Conclusion The exposure procedure of the recurrent laryngeal nerve in thyroid lobectomy helps to protect the recurrent laryngeal nerve,and GDNF could be a biological indicator to detect the recurrent laryngeal nerve function after thyroid lobectomy,which is expected to become the target direction of the treatment of recurrent laryngeal nerve injury.
Objective To discuss the clinical significance of the surgical exposure of recurrent laryngeal nerve in thyroid lobectomy. Methods Total of 200 patients with thyroid disease admitted to Changshou District People's Hospital from Mar. 2010 to Mar. 2013 were included and divided into a control group of 100 cases,and an observation group of 100 cases according to the random number table method: in the control group,there was no recurrent laryngeal nerve exposure procedure during the surgery; in the observation group there was recurrent laryngeal nerve exposure procedure during the surgery,then a six-month follow-up was done for both groups. The first day drainage amount,intraoperative blood loss,operative time,surgical flap area,parathyroid function,glial cell line-derived neurotrophic factor( GDNF) levels of the two groups were compared. Results Parathyroid damage rate in the observation group was lower than the control group[0. 0%( 0 /100) vs 5. 0%( 5 /100) ],the three months and six months recurrent laryngeal nerve injury rate of the observation group were lower than the control group[0. 0%( 0 /100) vs 3. 0%( 3 /100),8. 0%( 8 /100) vs 12. 0%( 12 /100) ],the differences weres statistically significant( P < 0. 05). Flaps area,operative time,blood loss,hospital stay,postoperative drainage volume on the first day of the observation group were less than the control group[( 123 ± 11) cm2vs( 146 ± 27) cm2,( 64 ± 7) min vs( 68 ± 11) min,( 8 ±3) m L vs( 56 ± 13) m L,( 8. 4 ± 1. 3) d vs( 14. 5 ± 1. 9) d,( 130 ± 5) m L vs( 180 ± 7) m L],the differences were statistically significant( P < 0. 01). The preoperative serum GDNF levels of the two were similar( P > 0. 05),while the postoperative GDNF level of patients with recurrent laryngeal nerve injury was decreased,by three months after surgery,GDNF level of the observation group was significantly higher than the control group( P < 0. 05),to six months after surgery,GDNF level of the observation group returned to preoperative level,but GDNF level of the control group was significantly lower( P < 0. 05). Conclusion The exposure procedure of the recurrent laryngeal nerve in thyroid lobectomy helps to protect the recurrent laryngeal nerve,and GDNF could be a biological indicator to detect the recurrent laryngeal nerve function after thyroid lobectomy,which is expected to become the target direction of the treatment of recurrent laryngeal nerve injury.
引文
[1]叶刚,李远平.甲状腺手术中常规解剖喉返神经的临床意义[J].临床耳鼻咽喉头颈外科杂志,2010,24(7):304-305.
[2]Ziv G,Snehal G.甲状腺癌手术——Memorial Sloan-KetteringCancer Center经验(一)[J].李平栋,于振坤,译.中华耳鼻咽喉头颈外科杂志,2011,46(9):787-791.
[3]刘晓莉,孙辉.喉返神经监测技术原理与临床运用[J].中国实用外科杂志,2012,32(5):409-411.
[4]高下,赵德安,黄维国.甲状腺切除病例喉返神经损伤的分析[J].临床耳鼻咽喉头颈外科杂志,2000,14(7):315-316.
[5]吴荣兴,夏利花,王文武.颈丛麻醉下显露喉返神经的甲状腺手术420例分析[J].临床外科杂志,2008,16(6):427-428.
[6]程若川,苏艳军,张建明.甲状腺手术方式和喉返神经显露与神经损伤的关系[J].中国普通外科杂志,2007,16(1):15-17.
[7]石磊,陈平,何春.甲状腺手术中显露喉返神经的安全性探讨[J].临床外科杂志,2012,20(7):471-472.
[8]曾繁余,张显岚,张帆,等.甲状腺腺叶切除术中喉返神经的保护[J].中华普通外科杂志,2012,27(4):286-288.
[9]高明,贾永胜.甲状腺外科中喉返神经处理的若干问题[J].中华普通外科杂志,2012,27(4):265-266.
[10]黄泽楠,黄群爱,刘宇,等.喉返神经实时监测与常规暴露在甲状腺手术中的比较[J/CD].中华临床医师杂志:电子版,2013,7(2):570-574.
[11]孙瑜宁,张恩东,孙彦.甲状腺腺叶切除术中两种不同解剖方法暴露喉返神经的临床观察[J].青岛医药卫生,2011,43(1):19-20.
[12]梁冬旭.甲状腺腺叶切除术中喉返神经入喉处解剖暴露的临床效果[J].现代医院,2014,14(11):43-45.
[13]冀峰,单建华,王景玉.暴露喉返神经在甲状腺手术中的意义[J].当代医学,2012,18(3):48.
[14]姜彦,董频,李晓艳,等.甲状腺手术中解剖喉返神经的意义[J].临床耳鼻咽喉头颈外科杂志,2008,22(12):544-546,550.
[15]阴英,王毅,姚远,等.甲状腺手术常规显露喉返神经对于预防喉返神经损伤的临床研究[J].实用医学杂志,2012,28(24):4133-4135.
[2]Ziv G,Snehal G.甲状腺癌手术——Memorial Sloan-KetteringCancer Center经验(一)[J].李平栋,于振坤,译.中华耳鼻咽喉头颈外科杂志,2011,46(9):787-791.
[3]刘晓莉,孙辉.喉返神经监测技术原理与临床运用[J].中国实用外科杂志,2012,32(5):409-411.
[4]高下,赵德安,黄维国.甲状腺切除病例喉返神经损伤的分析[J].临床耳鼻咽喉头颈外科杂志,2000,14(7):315-316.
[5]吴荣兴,夏利花,王文武.颈丛麻醉下显露喉返神经的甲状腺手术420例分析[J].临床外科杂志,2008,16(6):427-428.
[6]程若川,苏艳军,张建明.甲状腺手术方式和喉返神经显露与神经损伤的关系[J].中国普通外科杂志,2007,16(1):15-17.
[7]石磊,陈平,何春.甲状腺手术中显露喉返神经的安全性探讨[J].临床外科杂志,2012,20(7):471-472.
[8]曾繁余,张显岚,张帆,等.甲状腺腺叶切除术中喉返神经的保护[J].中华普通外科杂志,2012,27(4):286-288.
[9]高明,贾永胜.甲状腺外科中喉返神经处理的若干问题[J].中华普通外科杂志,2012,27(4):265-266.
[10]黄泽楠,黄群爱,刘宇,等.喉返神经实时监测与常规暴露在甲状腺手术中的比较[J/CD].中华临床医师杂志:电子版,2013,7(2):570-574.
[11]孙瑜宁,张恩东,孙彦.甲状腺腺叶切除术中两种不同解剖方法暴露喉返神经的临床观察[J].青岛医药卫生,2011,43(1):19-20.
[12]梁冬旭.甲状腺腺叶切除术中喉返神经入喉处解剖暴露的临床效果[J].现代医院,2014,14(11):43-45.
[13]冀峰,单建华,王景玉.暴露喉返神经在甲状腺手术中的意义[J].当代医学,2012,18(3):48.
[14]姜彦,董频,李晓艳,等.甲状腺手术中解剖喉返神经的意义[J].临床耳鼻咽喉头颈外科杂志,2008,22(12):544-546,550.
[15]阴英,王毅,姚远,等.甲状腺手术常规显露喉返神经对于预防喉返神经损伤的临床研究[J].实用医学杂志,2012,28(24):4133-4135.