喉返神经监测技术在分化型甲状腺癌中央区淋巴结清扫术中的临床应用

doi:10.3877/cma.j.issn.1674-0793.2016.06.014

中华普通外科学文献(电子版) ›› 2016, Vol. 10 ›› Issue (06) : 441 -444. doi: 10.3877/cma.j.issn.1674-0793.2016.06.014

所属专题：文献；

论著

喉返神经监测技术在分化型甲状腺癌中央区淋巴结清扫术中的临床应用

苏庆长¹, 张桂华¹, 孙善平¹, 解磐磐¹, 章阳¹^,^†(

)

^1. 252000　山东省聊城市人民医院乳腺甲状腺外科

收稿日期:2016-01-12 出版日期:2016-12-01
通信作者: 章阳

Application of recurrent laryngeal nerve monitoring in lymph node dissection of the central area of differentiated thyroid carcinoma

Qingchang Su¹, Guihua Zhang¹, Shanping Sun¹, Panpan Xie¹, Yang Zhang¹^,^†()

^1. Department of Breast and Thyroid Surgery, Liaocheng People's Hospital of Shandong Province, Liaocheng 252000, China

Received:2016-01-12 Published:2016-12-01
Corresponding author: Yang Zhang
About author:
Corresponding author: Zhang Yang, Email: zhangyang5366@163.com

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目的

探讨在分化型甲状腺癌（DTC）中央区（Ⅵ区）淋巴结清扫术中喉返神经监测技术（IONM）的应用价值。

方法

100例DTC患者分为应用IONM手术观察组（观察组）和不应用IONM手术对照组（对照组）各50例，比较两组手术相关指标的统计学差异。

结果

（1）观察组探查暴露喉返神经（RLN）的时间、中央区淋巴结清扫手术时间平均分别为（7.5±3.3）min、（15.2±4.8）min，对照组分别为（14.0±4.2）min、（21.6±6.1）min，两组差异均有统计学意义（t=9.134 5、5.830 2，P=0.000 0、0.000 0）。（2）观察组暂时性RLN损伤发生率为2.0%（1/50），未发生永久性RLN损伤。对照组暂时性RLN损伤发生率为6.0%（3/50），永久性RLN损伤发生率为2.0%（1/50），但差异无统计学意义。

结论

DTC患者中央区淋巴结清扫术中应用IONM可快速缩短探查暴露RLN的时间和有效保护RLN，还可能在一定程度上降低手术过程中RLN损伤的发生风险。但是任何仪器都不能改变手术操作本身是一项高风险技术的本质，该项技术可作为手术得力助手。

关键词: 甲状腺肿瘤, 淋巴结切除术, 喉返神经，监测

Objective

To explore the value of application of intra-operative recurrent laryngeal nerve monitoring (IONM) in lymph node dissection of the central area (Ⅵ area) of differentiated thyroid carcinoma (DTC).

Methods

One hundred patients suffered from DTC were divided into application group (observation group) and conventional surgery group (control group) with fifty patients in each. Patients in observation group were performed with IONM, as control, other patients in control group were performed on conventional operation without this technology, and then differences of several surgery related indexes between the two groups were compared.

Results

(1) Time used in exposing recurrent laryngeal nerve and lymph node dissection of central area in observation group was (7.5±3.3) min and (15.2±4.8) min in average, (14.0±4.2) min and (21.6±6.1) min in control group respectively, with statistical difference (t= 9.134 5, 5.830 2, both P<0.01). (2) The occurrence rate of temporary injury of RLN in observation group was 2.0% (1/50) and 6.0%(3/50) in control group. The occurrence rate of permanent nerve injury was 2.0% (1/50) in control group and none in observation group, with no statistical difference.

Conclusions

IONM in lymph node dissection of the central area may help to expose RLN more quickly, protect RLN more effectively, reduce the risk of RLN injury, thus it is conformed that application of this technology may have a certain value in lymph node dissection of the central area of DTC. It should be known that any equipment cannot change the high-risk technology as the essence of operation itself, and this technology may be used as efficient assistant for surgeons.

Key words: Thyroid neoplasms, Lymph node excision, Recurrent laryngeal nerve, monitoring

表1 两组分化型甲状腺癌患者手术相关指标比较

组别	例数	中央区清扫时间(min)	喉返神经探查暴露时间(min)	暂时性喉返神经损伤(%)	永久性喉返神经损伤(%)	术中出血量(ml)	住院费用（元）
观察组	50	15.2±4.8	7.5±3.3	2.0	0	15.6±3.5	13 540±1 068
对照组	50	21.6±6.1	14.0±4.2	6.0	2.0	17.3±3.9	20 748±1 260
统计值	?	t=5.830 2	t=9.134 5	χ²=1.041 7	χ²=1.010 1	t=2.293 9	t=30.857 4
P值	?	0.000 0	0.000 0	0.307 4	0.314 9	0.023 9	0.000 0

表1 两组分化型甲状腺癌患者手术相关指标比较

组别	例数	中央区清扫时间(min)	喉返神经探查暴露时间(min)	暂时性喉返神经损伤(%)	永久性喉返神经损伤(%)	术中出血量(ml)	住院费用（元）
观察组	50	15.2±4.8	7.5±3.3	2.0	0	15.6±3.5	13 540±1 068
对照组	50	21.6±6.1	14.0±4.2	6.0	2.0	17.3±3.9	20 748±1 260
统计值	?	t=5.830 2	t=9.134 5	χ²=1.041 7	χ²=1.010 1	t=2.293 9	t=30.857 4
P值	?	0.000 0	0.000 0	0.307 4	0.314 9	0.023 9	0.000 0

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