喉返神经监测在甲状腺癌二次手术淋巴结清扫术中的应用

发布时间：2019-04-17 18:57

【摘要】：目的:本研究主要是对比了用与不用喉返神经监测仪在治疗甲状腺癌二次手术淋巴结清扫术方面的效果。主要是研究了喉返神经监测在甲状腺癌二次手术中的使用情况,分析了此种辨认办法对喉返神经的识别,观察了左侧甲状腺癌和右侧甲状腺癌分别的手术时间以及手术处置期间的出血量、引流量和淋巴结的扫除数量,同时对比了应用喉返神经监测仪时左、右侧喉返神经在手术中的分离时间、损伤率等方面的差异,以便为临床研究提供一定的参考作用,同时还探讨了这种技术在淋巴结清除术中的使用意义,为其进一步扩大应用领域和手术应用起到一定促进作用。方法:本研究选择我院2015年1月到2016年12月期间收治的84例单侧甲状腺癌二次手术患者,左侧31例,右侧53例,将其分为两组,也即使用喉返神经监测仪组(IONM组)和非使用喉返神经监测仪组(非IONM组),前一组为42例,在手术中用喉返神经监测仪来查验、分离喉返神经,后一组42例,在处置期间用通常的暴露法肉眼直视分离喉返神经。术中、术后分别采集总的及IONM组左、右侧喉返神经分别的手术时间、出血量,声带受损情况。术后三天中每天的引流量,以及术后1天、术后1周、术后3月的声带运动情况。结果:左侧甲状腺癌、右侧甲状腺癌二次手术IONM组所用时间明显小于非IONM组(57.0±5.2和61.2±5.7分钟,P0.05;59.6±6.8和65.4±5.9,P0.05);平均在手术处置期间出血量两组差异不明显(10.6±3.4和12.7±4.2ml,P0.05;11.3.±4.5,12.7±5.6,P0.05);左侧甲状腺癌、右侧甲状腺癌手术处置后1、2、3天引流量IONM组均明显小于非IONM组(P0.05);术后1天声带运动异常IONM组要明显少于非IONM组(1例,2.3%;6例,14.2%,P0.05);术后1周声带运动异常IONM组明显少于非IONM组(0例,0%;4例,9.5%,P0.05);术后3月声带运动异常IONM组0例,非IONM组1例;IONM组左侧喉返神经所需要的分离时间明显少于右侧喉返神经分离时间(10.6±2.6min和16.5±3.2min,P0.05),但两者的损伤率无显著差异,(0%和4.5%,P0.05)。结论:本研究结果表明,利用喉返神经检测仪在进行甲状腺癌二次手术淋巴结清除术时具有一定优势,可以有效减少手术时间、引流量,同时可减少喉返神经损伤率,对术后恢复也有一定积极作用,同时会对喉返神经有保护作用,能有效的上升外科治疗后生活质量,不过在控制术中出血量和清除淋巴结数量方面没有显示出作用。IONM组左侧喉返神经比右侧喉返神经分离时间短,但两者的喉返神经损伤率无显著差异。这种检测会增加一部分治疗成本,因此在治疗甲状腺癌时,能够综合考虑适当选择应用喉返神经检测仪。
[Abstract]:Aim: the purpose of this study was to compare the effect of recurrent laryngeal nerve monitor (RLN) with or without recurrent laryngeal nerve (RLN) in the treatment of thyroid carcinoma by lymph node dissection. The main purpose of this paper is to study the use of recurrent laryngeal nerve monitoring in the secondary operation of thyroid cancer, and analyze the recognition of the recurrent laryngeal nerve by this method. The operation time of left thyroid cancer and right thyroid carcinoma were observed, and the amount of bleeding, drainage flow and the number of lymph node dissection were observed during the operation. Meanwhile, the left side was compared with the left side when using the recurrent laryngeal nerve monitor. The differences in separation time and injury rate of the right recurrent laryngeal nerve during operation are different in order to provide a certain reference for clinical study, and the significance of this technique in lymph node dissection is also discussed. It plays an important role in further expanding its application field and surgical application. Methods: from January 2015 to December 2016, 84 patients with unilateral thyroid carcinoma were divided into two groups: left side (31 cases) and right side (53 cases). Even if the recurrent laryngeal nerve monitor group (IONM group) and the non-use recurrent laryngeal nerve monitor group (non-IONM group), the former group of 42 cases, using the recurrent laryngeal nerve monitoring instrument to examine during the operation, separation of the recurrent laryngeal nerve, the latter 42 cases, The recurrent laryngeal nerve (RLN) was separated directly from the laryngeal nerve with the normal exposure method during the treatment. The operation time, bleeding volume and vocal cord damage of the left and right recurrent laryngeal nerves in the IONM group and the total group were collected after operation. Daily drainage and vocal cord movement 1 day, 1 week and 3 months after operation. Results: the time of second operation of left thyroid carcinoma and right thyroid carcinoma in IONM group was significantly shorter than that in non-IONM group (57.0 卤5.2,61.2 卤5.7min, P 0.05 卤6.8,65.4 卤5.9, P0.05). There was no significant difference in blood loss between the two groups (10.6 卤3.4,12.7 卤4.2 ml, P 0.05 卤11.3 卤4.5, 12.7 卤5.6, P0.05). The drainage flow in IONM group was significantly lower than that in non-IONM group on the 1st, 2nd and 3rd day after surgical management of left thyroid carcinoma and right thyroid carcinoma (P0.05), and the vocal cord movement abnormality in IONM group was significantly less than that in non-IONM group on the 1st day after operation (2.3%). 6 cases (14.2%, P0.05), 1 week after operation, the vocal cord movement abnormality in IONM group was significantly lower than that in non-IONM group (0 cases, 0%, 4 cases, 9.5%, P0.05), 3 months after operation, there were 0 cases in IONM group and 1 case in non-IONM group. The separation time of left recurrent laryngeal nerve in the IONM group was significantly shorter than that in the right recurrent laryngeal nerve (10.6 卤2.6min vs 16.5 卤3.2 min, P0.05), but there was no significant difference in the injury rate between the two groups (0% and 4.5%, P0.05). Conclusion: the results of this study show that the RLN detector has some advantages in the second operation of thyroid carcinoma. It can effectively reduce the operation time and drainage volume, and reduce the rate of recurrent laryngeal nerve injury at the same time. It also has a positive effect on postoperative recovery, and also has a protective effect on the recurrent laryngeal nerve, which can effectively improve the quality of life after surgical treatment. In the IONM group, the separation time of the left recurrent laryngeal nerve was shorter than that of the right recurrent laryngeal nerve, but there was no significant difference in the injury rate of the RLN between the IONM group and the right RLN group. This test will increase some of the cost of treatment, so when treating thyroid cancer, it is possible to consider the proper choice of RLN detector in the treatment of thyroid cancer.
【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】：R736.1

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