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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

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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. 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. 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:
引用本文:

苏庆长, 张桂华, 孙善平, 解磐磐, 章阳. 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[J/OL]. 中华普通外科学文献(电子版), 2016, 10(06): 441-444.

Qingchang Su, Guihua Zhang, Shanping Sun, Panpan Xie, Yang Zhang. Application of recurrent laryngeal nerve monitoring in lymph node dissection of the central area of differentiated thyroid carcinoma[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2016, 10(06): 441-444.

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。

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.

表1 两组分化型甲状腺癌患者手术相关指标比较
1
Dimov RS,Doikov IJ,Mitov FS, et al. Intraoperative identifica-tion of recurrent laryngeal nerves in thyroid surgery by electrical stimulation[J]. Folia Med (Polvdiv), 2001, 43(4): 10-13.
2
方国恩,施俊义,盛援,等.甲状腺疾病3 091例外科治疗分析[J].中国实用外科杂志, 2004, 24(10): 596-599.
3
刘继远,韦善文,桂雄斌.甲状腺良性病变手术与喉返神经损伤[J].耳鼻咽喉-头颈外科, 2003, 10(6): 333-334.
4
Chiang FY,Lu IC,Kuo WR, et al. The mechanism of recurrent la-ryngeal nerve injury during thyroid surgery, the application of in-traoperative neuromonitoring[J]. Surgery, 2008, 143(6): 743-749.
5
Forest VI,Clark JR,Ebrahimi A, et al. Central compartment dis-section in thyroid papillary carcinoma[J]. Ann Surg, 2011, 253(1): 123-130.
6
Wierzbicka M,Wasniewska E,Szyfter W. Management of thyroid cancer metastases in lymph nodes[J]. Otolaryngol Pol, 2008, 62(3): 267-271.
7
张浩.重视甲状腺乳头状癌治疗中Ⅵ区淋巴结清扫术的临床价值[J].中国实用外科杂志, 2011, 31(5): 391.
8
张建,章菊琴,邬振华,等.显露喉返神经在甲状腺手术中的意义[J].临床耳鼻咽喉头颈外科杂志, 2012, 26(3): 118-119.
9
姜华,李玺,刘仁斌,等.喉肌电活动实时监测喉返神经在再次甲状腺手术中的应用[J/CD].中华普通外科学文献:电子版, 2014, 8(1): 4-7.
10
Sarı S,Erbil Y,Sümer A, et al. Evaluation of recurrent laryngeal nerve monitoring in thyroid surgery[J]. Int J Surg, 2010, 8(6): 474-478.
11
Barczyński M,Konturek A,Cichoń S. Randomized clinical trial of visualization versus neuro monitoring of recurrent laryngeal nerves during thyroidectomy[J]. Br J Surg, 2009, 96(3): 240-246.
12
Barczyński M,Konturek A,Stopa M, et al. Clinical value of intra-operative neuromonitoring of the recurrent laryngeal nerves in im-proving outcomes of surgery for well-differentiated thyroid cancer[J]. Pol Przegl Chir, 2011, 83(4): 196-203.
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