甲状腺再次手术中预防喉返神经损伤116例临床剖析.docVIP

甲状腺再次手术中预防喉返神经损伤116例临床剖析 　　[摘要] 目的:探讨甲状腺再次手术中喉返神经损伤的预防方法。方法:对116例甲状腺再次手术患者分两组进行分析,未解剖组65例,其中甲状腺癌38例,良性甲状腺疾病27例;解剖组51例,其中甲状腺癌35例,良性甲状腺疾病16例。结果:在甲状腺癌中未解剖组损伤8例,损伤率为21.1%;解剖组损伤1例,损伤率为2.9%;两者之间差异有统计学意义(P0.05)。结论:甲状腺癌再次手术中显露喉返神经可以降低喉返神经损伤的发生率。? 　　[关键词] 甲状腺疾病; 再次手术; 喉返神经损伤? 　　[中图分类号] R581 [文献标识码] A [文章编号] 1671-7562(2010)04-0347-03? 　　doi:10.3969/j.issn.1671-7562.2010.04.007?? 　　 　　Clinical analysis of prevention of recurrent laryngeal nerve injury in ? 　　reoperation of thyroid surgery on 116 cases?? 　　LIU Li?min, WU Chi, ZENG Xiao?bing, ZHU Yong?qi, LIU Ya?min, CHEN Yong 　　(Department of General Surgery, Baoshan Central Hospital of Baoshan District, Shanghai 201900, China)?? 　　[Abstract] Objective: To explore the prevention of recurrent laryngeal nerve(RLN) injury in reoperation of thyroid surgery. Methods: In this study, 116 patients admitted in our hospital from january 1980 to december 2009 were divided into two groups: RLN exposure group (51 cases) and RLN non?exposure group (65 cases). 38 cases of thyroid cancer and 27 cases of benign thyroid neoplasm were in RLN non?exposure group. 35 cases of thyroid cancer and 16 cases of benign thyroid neoplasm were in RLN exposure group. Results: 8 cases of thyroid cancer (21.1%) suffered from RLN injury in non?exposure group, one case of thyroid cancer (2.9%) suffered from RLN injury in exposure group, there was significant difference between them (P0.05). Conclusion: Exposure of RLN can greatly decrease RLN injury in reoperation of thyroid cancer.? 　　[Key words] thyroid disease; reoperation; recurrent laryngeal nerve injury?? 　　 　　 　　 喉返神经损伤是甲状腺手术中常见的并发症,尤其在甲状腺再次手术时,由于原手术区解剖关系不清,极易发生喉返神经损伤。如何降低喉返神经损伤率是头颈外科研究的重要课题。笔者回顾性分析我院1980年1月至2009年12月间甲状腺再次手术的经验,探讨防止喉返神经损伤的方法。? 　　 　　1 资料与方法? 　　1.1 一般资料? 　　1980年1月至2009年12月我科完成甲状腺手术1 832例,再次手术116例,占总体的6.3%。其中男51例,女65例,年龄25~73岁,平均45.1岁,再次手术距首次手术时间为1周～10年。再手术病人分为喉返神经未解剖组65例和解剖组51例。其中甲状腺癌再次手术者73例,占再手术病例的62.9%。甲状腺癌再手术病例中未解剖组38例,占再手术病例的32.8%;解剖组35例,占再手术病例的30.2%。良性甲状腺疾病再次手术者43例,占