经腋窝入路腔镜甲状腺手术中喉返神经暴露组与非暴露组的临床对比研究

发布时间：2018-03-28 00:33

本文选题：腋窝入路　切入点：良性甲状腺疾病　出处：《广西医科大学》2015年硕士论文

【摘要】：目的探讨经腋窝入路腔镜甲状腺手术中喉返神经暴露组与非暴露组的必要性,可行性及临床对比研究,从而提升内镜甲状腺手术质量及安全性。方法本研究为回顾性分析。选取77例良性甲状腺疾病患者,其手术方式均为经腋窝入路。按照术中是否进行暴露喉返神经分为2个研究组：其中暴露组49例,非暴露组28例的病例资料以及随访资料。进行总结和比较两组喉返神经损伤,手术时间,术中出血量,住院天数,以及其他并发症发生率,推断两种手术方式的优缺点,从而评价其临床价值。结果77例手术均在经腋窝入路腔镜下完成,无中转开放手术。暴露喉返神经组49例当中有0例喉返神经损伤,其损伤率为(0%)；非暴露组28例当中有5例喉返神经损伤,其损伤率为(17.85%),均经电子喉镜检查证实；暴露组明显低于非暴露组,两组喉返神经损伤率差异有统计学意义(X2=9.649,P=0.0020.05),两组手术时间(t=-0.195,P=0.846),住院天数(t=1.423,P=0.156),术中出血均(t=1.423,P=0.156)均无统计学意义。结论经腋窝入路腔镜甲状腺手术中暴露喉返神经能有效防止喉返神经损伤,并且未增加手术并发症,对于结节性甲状腺肿、行甲状腺腺叶次全切、或肿块数目多,应该常规进行解剖暴露喉返神经。
[Abstract]:Objective to explore the necessity, feasibility and clinical comparison of recurrent laryngeal nerve exposure group and non-exposure group in endoscopic thyroidectomy via axillary approach. In order to improve the quality and safety of endoscopic thyroid surgery, 77 patients with benign thyroid disease were selected for retrospective analysis. According to whether the recurrent laryngeal nerve was exposed during the operation, the patients were divided into two groups: 49 cases in the exposed group, 28 cases in the non-exposed group, and the follow-up data. The injury of the recurrent laryngeal nerve was summarized and compared between the two groups. The time of operation, the amount of blood lost during operation, the length of hospitalization, the incidence of other complications, and the advantages and disadvantages of the two surgical methods were inferred to evaluate their clinical value. There were 0 cases of recurrent laryngeal nerve injury in 49 cases of exposed recurrent laryngeal nerve group, 5 cases of recurrent laryngeal nerve injury in 28 cases of non-exposure group, and 17.85% injury rate of recurrent laryngeal nerve injury, all of which were confirmed by electronic laryngoscopy. The exposure group was significantly lower than the non-exposed group. There was no significant difference in the injury rate of recurrent laryngeal nerve between the two groups. There was no significant difference in the injury rate of recurrent laryngeal nerve between the two groups. Conclusion exposure of recurrent laryngeal nerve through axillary approach can effectively prevent recurrent laryngeal nerve injury during endoscopic thyroidectomy. For nodular goiter subtotal thyroidectomy or large number of masses the recurrent laryngeal nerve should be dissected routinely.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R653

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