术中喉返神经监测技术在完全腔镜甲状腺手术中的应用研究

发布时间：2018-03-22 19:52

本文选题：完全腔镜甲状腺手术　切入点：术中神经监测技术　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:内镜甲状腺手术凭借其美观的优势已经发展较为成熟,但因颈部解剖特点,故操作空间小,喉返神经的损伤为非常严重的手术并发症,有研究表明术中神经监测仪的应用大大降低了开放甲状腺手术喉返神经损伤的概率,目前术中喉返神经监测技术在内镜甲状腺手术中应用的研究较少,本文通过对比术中是否应用神经监测仪,来评价该技术是否有优势。方法:研究包含了山东大学齐鲁医院自2011年至2014年收治并决定行完全腔镜甲状腺手术的患者共74人,其中术中应用神经监测仪39人,未使用神经监测仪35人,术后统计比较两组术式的性别、年龄、手术有关数据、住院时间、患者主观感受等进行对比研究,从而评价其优缺点。结果:(1)手术情况:两组患者平均年龄、性别组成、肿瘤大小和良恶性比例均无显著差异。平均手术时间使用神经监测仪组小于未使用神经监测仪组(98.6±37.9 min vs 136.7±45.3 min,P0.05),术中出血无明显差异(23.3±6.72 ml vs 26.5±7.65 ml,P0.05)。(2)术后情况:术后未使用神经监测仪组出现2例暂时性声音嘶哑,无永久性声音嘶哑。术后疼痛评分VAS(Visual analogue scales,视觉模糊评分)两组无显著差异(2.3±0.92 vs 2.0±0.91,P0.05);术后3天RSI评分(The Reflux Symptom Index,反流症状指数量表)无显著差异(23.2±7.21 vs 26.1±6.80,P0.05);术后引流量(132.1±40.50 ml vs 121.3±30.65 ml P0.05)及住院天数(4.0±1.32天vs 4.0±1.43天,P0.05)均无显著差异;术后3个月随访:VHI(Voice Handicap Index,嗓音障碍指数)无显著差异(0.6±0.31 vs 0.7±0.42,P0.05)。结论:术中神经监测技术在腔镜甲状腺手术中的应用能够帮助手术医师更加熟练顺畅的完成手术,对提高手术效率有一定帮助。对于术后并发症(喉返神经的损伤)的预防,有一定帮助。
[Abstract]:Objective: endoscopic thyroidectomy has been developed due to its beautiful advantages, but because of the anatomical characteristics of the neck, the operation space is small, and the injury of recurrent laryngeal nerve is a very serious complication. Some studies have shown that the application of intraoperative nerve monitor has greatly reduced the probability of recurrent laryngeal nerve injury in open thyroid surgery. At present, the application of intraoperative recurrent laryngeal nerve monitoring technique in endoscopic thyroid surgery is less than that in endoscopic thyroid surgery. In this paper, we compared the use of neuromonitor during operation to evaluate the advantages of this technique. Methods: the study included 74 patients who were admitted to Qilu Hospital of Shandong University from 2011 to 2014 and decided to perform complete endoscopic thyroidectomy. Among them, 39 cases were treated with nerve monitor during operation and 35 cases were not. The sex, age, operation data, hospitalization time, subjective feeling of the patients were compared and compared between the two groups. Results: the average age and gender composition of the two groups were as follows:. There was no significant difference in the size of tumor and the ratio of benign and malignant tumor. The mean operation time in the neuromonitor group was 98.6 卤37.9 min vs 136.7 卤45.3 min, and there was no significant difference in the intraoperative bleeding (23.3 卤6.72 ml vs 26.5 卤7.65 ml P0.05. 2). There were 2 cases of temporary hoarseness in the nerve monitor group. There was no permanent hoarseness. There was no significant difference in postoperative pain score (VAS(Visual analogue scales, visual fuzzy score) between the two groups (2.3 卤0.92 vs 2.0 卤0.91g / P 0.05), and there was no significant difference in the Reflux Symptom index (reflux symptom index) between the two groups on the 3rd day after operation (23.2 卤7.21 vs 26.1 卤6.80P0.05; postoperative drainage: 132.1 卤40.50ml). There was no significant difference between the two groups (121.3 卤30.65 ml, P0.05) and hospitalization days (4.0 卤1.32 days vs 4.0 卤1.43 days, P0.05). There was no significant difference in 3 months after operation between the two groups. Conclusion: the application of intraoperative nerve monitoring technique in endoscopic thyroid surgery can help the surgeon to complete the operation more skillfully and smoothly. It is helpful for the prevention of postoperative complications (injury of recurrent laryngeal nerve).
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R653

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