本文選題：完全腔鏡甲狀腺手術(shù)　切入點：術(shù)中神經(jīng)監(jiān)測技術(shù)　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:內(nèi)鏡甲狀腺手術(shù)憑借其美觀的優(yōu)勢已經(jīng)發(fā)展較為成熟,但因頸部解剖特點,故操作空間小,喉返神經(jīng)的損傷為非常嚴(yán)重的手術(shù)并發(fā)癥,有研究表明術(shù)中神經(jīng)監(jiān)測儀的應(yīng)用大大降低了開放甲狀腺手術(shù)喉返神經(jīng)損傷的概率,目前術(shù)中喉返神經(jīng)監(jiān)測技術(shù)在內(nèi)鏡甲狀腺手術(shù)中應(yīng)用的研究較少,本文通過對比術(shù)中是否應(yīng)用神經(jīng)監(jiān)測儀,來評價該技術(shù)是否有優(yōu)勢。方法:研究包含了山東大學(xué)齊魯醫(yī)院自2011年至2014年收治并決定行完全腔鏡甲狀腺手術(shù)的患者共74人,其中術(shù)中應(yīng)用神經(jīng)監(jiān)測儀39人,未使用神經(jīng)監(jiān)測儀35人,術(shù)后統(tǒng)計比較兩組術(shù)式的性別、年齡、手術(shù)有關(guān)數(shù)據(jù)、住院時間、患者主觀感受等進(jìn)行對比研究,從而評價其優(yōu)缺點。結(jié)果:(1)手術(shù)情況:兩組患者平均年齡、性別組成、腫瘤大小和良惡性比例均無顯著差異。平均手術(shù)時間使用神經(jīng)監(jiān)測儀組小于未使用神經(jīng)監(jiān)測儀組(98.6±37.9 min vs 136.7±45.3 min,P0.05),術(shù)中出血無明顯差異(23.3±6.72 ml vs 26.5±7.65 ml,P0.05)。(2)術(shù)后情況:術(shù)后未使用神經(jīng)監(jiān)測儀組出現(xiàn)2例暫時性聲音嘶啞,無永久性聲音嘶啞。術(shù)后疼痛評分VAS(Visual analogue scales,視覺模糊評分)兩組無顯著差異(2.3±0.92 vs 2.0±0.91,P0.05);術(shù)后3天RSI評分(The Reflux Symptom Index,反流癥狀指數(shù)量表)無顯著差異(23.2±7.21 vs 26.1±6.80,P0.05);術(shù)后引流量(132.1±40.50 ml vs 121.3±30.65 ml P0.05)及住院天數(shù)(4.0±1.32天vs 4.0±1.43天,P0.05)均無顯著差異;術(shù)后3個月隨訪:VHI(Voice Handicap Index,嗓音障礙指數(shù))無顯著差異(0.6±0.31 vs 0.7±0.42,P0.05)。結(jié)論:術(shù)中神經(jīng)監(jiān)測技術(shù)在腔鏡甲狀腺手術(shù)中的應(yīng)用能夠幫助手術(shù)醫(yī)師更加熟練順暢的完成手術(shù),對提高手術(shù)效率有一定幫助。對于術(shù)后并發(fā)癥(喉返神經(jīng)的損傷)的預(yù)防,有一定幫助。
[Abstract]:Objective: endoscopic thyroidectomy has been developed due to its beautiful advantages, but because of the anatomical characteristics of the neck, the operation space is small, and the injury of recurrent laryngeal nerve is a very serious complication. Some studies have shown that the application of intraoperative nerve monitor has greatly reduced the probability of recurrent laryngeal nerve injury in open thyroid surgery. At present, the application of intraoperative recurrent laryngeal nerve monitoring technique in endoscopic thyroid surgery is less than that in endoscopic thyroid surgery. In this paper, we compared the use of neuromonitor during operation to evaluate the advantages of this technique. Methods: the study included 74 patients who were admitted to Qilu Hospital of Shandong University from 2011 to 2014 and decided to perform complete endoscopic thyroidectomy. Among them, 39 cases were treated with nerve monitor during operation and 35 cases were not. The sex, age, operation data, hospitalization time, subjective feeling of the patients were compared and compared between the two groups. Results: the average age and gender composition of the two groups were as follows:. There was no significant difference in the size of tumor and the ratio of benign and malignant tumor. The mean operation time in the neuromonitor group was 98.6 鹵37.9 min vs 136.7 鹵45.3 min, and there was no significant difference in the intraoperative bleeding (23.3 鹵6.72 ml vs 26.5 鹵7.65 ml P0.05. 2). There were 2 cases of temporary hoarseness in the nerve monitor group. There was no permanent hoarseness. There was no significant difference in postoperative pain score (VAS(Visual analogue scales, visual fuzzy score) between the two groups (2.3 鹵0.92 vs 2.0 鹵0.91g / P 0.05), and there was no significant difference in the Reflux Symptom index (reflux symptom index) between the two groups on the 3rd day after operation (23.2 鹵7.21 vs 26.1 鹵6.80P0.05; postoperative drainage: 132.1 鹵40.50ml). There was no significant difference between the two groups (121.3 鹵30.65 ml, P0.05) and hospitalization days (4.0 鹵1.32 days vs 4.0 鹵1.43 days, P0.05). There was no significant difference in 3 months after operation between the two groups. Conclusion: the application of intraoperative nerve monitoring technique in endoscopic thyroid surgery can help the surgeon to complete the operation more skillfully and smoothly. It is helpful for the prevention of postoperative complications (injury of recurrent laryngeal nerve).
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R653

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