[1]张兆宏,刘　翔,王兆阳,等.全乳晕腔镜甲状腺癌根治术对甲状腺癌患者喉返神经的影响[J].新乡医学院学报,2020,37(8):743-746.[doi:10.7683/xxyxyxb.2020.08.009]
　ZHANG Zhaohong,LIU Xiang,WANG Zhaoyang,et al.Effect of total areola endoscopic thyroidectomy on the recurrent laryngeal nerve in patients with thyroid cancer[J].Journal of Xinxiang Medical University,2020,37(8):743-746.[doi:10.7683/xxyxyxb.2020.08.009]
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全乳晕腔镜甲状腺癌根治术对甲状腺癌患者喉返神经的影响
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年8
页码:
743-746
栏目:
临床研究
出版日期:
2020-08-05

文章信息/Info

Title:
Effect of total areola endoscopic thyroidectomy on the recurrent laryngeal nerve in patients with thyroid cancer
作者:
张兆宏; 刘　翔; 王兆阳; 黄晶晶; 张　楠
(河南中医药大学第一附属医院普外腔镜微创外科，河南　郑州　450000)
Author(s):
ZHANG Zhaohong; LIU Xiang; WANG Zhaoyang; HUANG Jingjing; ZHANG Nan
(Department of Laparoscopic of General Surgery,the First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou 450000,Henan Province,China)
关键词:
甲状腺癌; 腔镜甲状腺癌根治术; 喉返神经; 嗓音及吞咽功能
Keywords:
thyroid cancer; endoscopic thyroidectomy; recurrent laryngeal nerve; voice and swallowing function
分类号:
R736.1
DOI:
10.7683/xxyxyxb.2020.08.009
文献标志码:
A
摘要:
目的　探讨全乳晕腔镜甲状腺癌根治术对甲状腺癌患者喉返神经的影响，评估腔镜甲状腺手术的优势。方法　选择2017年10月至2019年10月河南中医药大学第一附属医院普外腔镜微创外科收治的120例女性甲状腺癌患者为研究对象，根据治疗方法分为腔镜组和开放组，每组60例。腔镜组患者采用全乳晕腔镜甲状腺癌根治术。开放组患者采用常规甲状腺乳头状癌根治术。比较2组患者手术时间、术中出血量、术后引流管拔管时间、住院时间及术后喉返神经显露比例，采用疼痛视觉模拟评分法(VAS)评估2组患者术后1、2、3 d的疼痛程度，采用嗓音障碍指数(VHI)评估2组患者术后1周及1个月的嗓音障碍程度，采用吞咽障碍评分量表（SIS) 评估2组患者术后1周及1个月的吞咽功能障碍情况，术后1个月行电子喉镜检查观察2组患者声带病变情况。结果　腔镜组患者手术时间、术中出血量、术后引流管拔管时间及住院时间均显著小于开放组（P<0.01）。腔镜组患者术中喉返神经显露60例（100.0%），开放组患者术中喉返神经显露59例（98.3%），2组患者术中喉返神经显露比例比较差异无统计学意义（χ2=1.011，P>0.05）。腔镜组患者术后 1、2、3 d 的VAS评分均显著小于开放组（P<0.01）。腔镜组患者术后 1周声带病变0例（0%），开放组患者术后1周声带病变9例(15.00%),腔镜组患者术后 1周声带病变率显著低于开放组（χ2=9.730，P<0.05）。腔镜组患者术后1周、1个月均未发生嗓音障碍和吞咽功能障碍；开放组患者术后 1周发生嗓音障碍8例(13.33%)、吞咽功能障碍5例(8.33%)，术后1个月无嗓音障碍和吞咽功能障碍；腔镜组患者术后1周嗓音障碍、吞咽功能障碍发生率显著低于开放组（χ2=8.217、5.219,P<0.05）。结论　腔镜甲状腺癌根治术手术创伤小，出血少，且喉返神经损伤及嗓音障碍、吞咽功能障碍发生率低，能够提高患者术后生活质量。
Abstract:
Objective　To explore the effect of total areola endoscopic thyroidectomy on recurrent laryngeal nerve in patients with thyroid cancer,and evaluate the advantages of endoscopic thyroidectomy.Methods　From October 2017 to October 2019,120 female patients with thyroid cancer in Minimally Invasive Surgery of General Surgery in the First Affiliated Hospital of Henan University of Traditional Chinese Medicine were selected as the research objects.According to the treatment methods,they were divided into endoscopic group and open group,with 60 cases in each group.The patients in endoscopic group were treated with total areola endoscopic thyroidectomy. The patients in the open group were treated with conventional radical thyroidectomy.The operation time,intraoperative bleeding volume,postoperative drainage tube extubation stay,hospitalization stay and the proportion of recurrent laryngeal nerve exposure were compared between the two groups.The visual analogue scale (VAS) was used to evaluate the pain degree of patients in the two groups at 1,2,3 days after operation.The voice handicap index (VHI) was used to evaluate the voice disorder degree of patients in the two groups at 1 week and 1 month after operation.Swallowing impairment score (SIS) was used to evaluate the swallowing dysfunction of the 2 groups at 1 week and 1 month after surgery,and the vocal cord lesions of the 2 groups were observed by electronic laryngoscope at 1 month after surgery.Results　The operation time,intraoperative bleeding volume,postoperative drainage tube extubation time and hospitalization stay in the endoscopic group were significantly less than those in the open group (P<0.01).There were 60 cases (100.0%) of recurrent laryngeal nerve exposure in endoscopic group and 59 cases (98.3%) in open group,and there was no significant difference between the two groups (χ2=1.011,P>0.05).The VAS scores of the endoscopic group were significantly lower than those of the open group at 1,2 and 3 days after operation (P<0.01).There were 0 cases (0%) of vocal cord lesions in the endoscopic group and 9 cases (15.00%) in the open group at 1 week after operation.The incidence of vocal cord lesions in the endoscopic group was lower than that in the open group at 1 week after operation (χ2=9.730,P<0.05).In the endoscopic group,there was no voice disorder or swallowing dysfunction at 1 week and 1 month after operation.In the open group,there were 8 cases (13.33%) of voice disorders and 5 cases (8.33%) of swallowing dysfunction at 1 week after operation,and no voice and swallowing dysfunction occurred in 1 month after operation in the open group;the incidence of voice disorder and swallowing dysfunction in the endoscopic group was lower than those in the open group at 1 week after operation,and the difference was statistically significant (χ2=8.217,5.219;P<0.05).Conclusion　Endoscopic thyroidectomy has less surgical trauma,less bleeding,and a low incidence of recurrent laryngeal nerve injury,voice disorder and swallowing dysfunction,which can improve the quality of life of patients.

参考文献/References:

［1］　陶崇翥,陈卫华,刘彦.全乳晕入路腔镜甲状腺微小乳头状癌根治术:附23例报告［J］.中国普通外科杂志,2017，26(11):27-31.
［2］　郑传铭,毛晓春,王佳峰,等.无充气腋窝入路全乳晕腔镜甲状腺癌根治术效果初步评价初期体会［J］.中国肿瘤临床,2018,45(1):27-28.
［3］　郭榆江，吴政龙，吕夕东，等.甲状腺手术中喉返神经损伤的类型和处理［J］.中国现代手术学杂志，2017，19（5）：335-337.
［4］　中华医学会内分泌学分会,中华医学会外科学分会,中国抗癌协会头颈肿瘤专业委员会,等．甲状腺结节和分化型甲状腺癌诊治指南［J］.中国肿瘤临床,2012,39(17):1249-1271.
［5］　彭瑶,白宁,王文龙,等.全乳晕腔镜途径与传统开放手术治疗T1期乳头状甲状腺癌的疗效比较［J］.中国普通外科杂志,2018，27(5):535-540.
［6］　QU R,GUO Y,HU X，et al．Endoscopic thyroid surgeries via areola approach:experience and outcomes of 500 cases in a single institute［J］.Indian J Surg,2018,23(6):1-6．
［7］　王中林,潘忠良,饶尚锐,等.全乳晕入路腔镜甲状腺手术与开放手术在甲状腺微小乳头状癌中的比较研究［J］.中华普通外科杂志,2018，33(3):252-253.
［8］　董朝,杨乐,刘春生,等.全腔镜下甲状腺癌根治术与传统开放性手术的临床效果比较［J］.新疆医科大学学报,2016,39(3):88-91.
［9］　王平，谢秋萍．腔镜甲状腺手术临床应用争议和共识［J］.中国实用外科杂志,2015,35(1):76-78.
［10］　潘勐,王亚兵，陈剑平，等.腔镜甲状腺手术治疗甲状腺微小乳头状癌的疗效及体会［J］.腹腔镜外科杂志,2018,23(11):861-864.
［11］　中国医师协会外科医师分会甲状腺外科医师委员会，中华医学会外科学分会甲状腺及代谢外科学组，中国研究型医院学会甲状腺疾病专业委员会．甲状腺围手术期甲状旁腺功能保护指南(2018版)［J］．中国实用外科杂志,2018，38(10):1108-1113．
［12］　胡小池,霍金龙,瞿锐,等.全乳晕腔镜甲状腺手术对患者嗓音及吞咽功能的影响［J］.中国普通外科杂志,2019,28(11):1367-1373.

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更新日期/Last Update: 2020-08-05