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。
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.
作者
张兆宏
刘翔
王兆阳
黄晶晶
张楠
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)
出处
《新乡医学院学报》
CAS
2020年第8期743-746,共4页
Journal of Xinxiang Medical University
基金
河南省科技攻关项目(编号:182102310606)。
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
thyroid cancer
endoscopic thyroidectomy
recurrent laryngeal nerve
voice and swallowing function
