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目的探讨甲状腺癌手术中显露喉返神经的必要性及喉返神经损伤的预防和处理。方法回顾蚌埠医学院第一、二附属医院肿瘤外科自2007年1月-2010年11月期间128例甲状腺癌临床病例资料,以术中是否解剖显露喉返神经分为常规显露组和不显露组,和以初次手术和再次手术分组,χ2检验分别比较分析两组间喉返神经损伤的发生率。结果常规显露组RLN永久性损伤1例,损伤率1.11%(1/90);不显露组损伤3例,损伤率7.89%(3/38),都是暂时性损伤。初次手术RLN损伤2例,损伤率1.87%(2/107);再次手术损伤2例,损伤率9.52%(2/21)。常规显露组与不显露组、初次手术与再次手术的RLN损伤差异均有统计学意义(P<0.05)。结论甲状腺癌手术中熟悉喉返神经的正常解剖和变异,常规显露喉返神经,可以有效预防和减少其损伤。
Objective To investigate the necessity of exposing recurrent laryngeal nerve and the prevention and treatment of recurrent laryngeal nerve injury during thyroid cancer surgery. Methods The clinical data of 128 cases of thyroid cancer from January 2007 to November 2010 in Department of Oncology, the First and Second Affiliated Hospital of Bengbu Medical College were retrospectively analyzed. Whether the intraoperative recanalization of the recurrent laryngeal nerve was divided into routine exposure group and non-exposure group , And to the first surgery and re-operation grouping, χ2 test were compared between the two groups the incidence of recurrent laryngeal nerve injury. Results In the conventional group, one case of permanent RLN injury was found, the rate of injury was 1.11% (1/90). No injury was found in 3 cases and the rate of injury was 7.89% (3/38). All of them were transient injuries. In the first operation, 2 cases of RLN were injured, the rate of injury was 1.87% (2/107). Two cases of reoperation were injured, the rate of injury was 9.52% (2/21). There were significant differences in RLN injury between the first operation and the second operation in the conventional group and the non-exposed group (P <0.05). Conclusion Thyroid cancer is familiar with the normal anatomy and variation of the recurrent laryngeal nerve during thyroidectomy. Routine recurrent laryngeal nerve can be effectively prevented and lessened.