發(fā)布時間：2018-08-01 14:31

【摘要】：目的探討甲狀腺手術(shù)中神經(jīng)監(jiān)測技術(shù)(IONM)的應(yīng)用價值。方法收集2015年8月至2016年10月在廣西醫(yī)科大學(xué)第一附屬醫(yī)院胃腸腺體外科行甲狀腺手術(shù)且術(shù)前電子喉鏡檢查正常的445例患者資料。其中使用神經(jīng)監(jiān)測技術(shù)術(shù)中監(jiān)測喉返神經(jīng)213例,共探查顯露喉返神經(jīng)358條(神經(jīng)監(jiān)測組),術(shù)中常規(guī)顯露喉返神經(jīng)232例,顯露喉返神經(jīng)379條(常規(guī)顯露組)。比較兩組術(shù)后暫時性喉返神經(jīng)損傷、永久性喉返神經(jīng)損傷、手術(shù)時間、術(shù)中出血量、術(shù)后引流量、拔管時間、住院時間以及住院費用的差異。結(jié)果神經(jīng)監(jiān)測組暫時性RLN損傷率較常規(guī)顯露組低,暫時性RLN損傷率分別為1.40%vs.5.28%,差異有統(tǒng)計學(xué)意義(P0.05),神經(jīng)監(jiān)測組永久性RLN損傷率也較常規(guī)顯露組低,分別為0.28%vs.1.06%,但差異無統(tǒng)計學(xué)意義(P0.05);神經(jīng)監(jiān)測組手術(shù)時間、術(shù)中出血量、術(shù)后引流量、術(shù)后拔管時間及住院時間較常規(guī)顯露組少,其中兩組平均手術(shù)時間分別為163.71±79.26 min vs.192.62±100.60 min,差異有統(tǒng)計學(xué)意義(P0.05);兩組平均術(shù)中出血量分別為36.77±29.85 ml vs.57.41±29.95 ml,差異有統(tǒng)計學(xué)意義(P0.05);兩組平均術(shù)后引流量分別為59.81±53.49 ml vs.89.80±70.39 ml,差異有統(tǒng)計學(xué)意義(P0.05);兩組平均術(shù)后拔管時間分別為2.16±1.31 d vs.3.16±1.18 d,差異有統(tǒng)計學(xué)意義(P0.05);兩組平均住院時間分別為7.60 d±2.24 d vs.8.22±2.12 d,差異有統(tǒng)計學(xué)意義(P0.05)。神經(jīng)監(jiān)測組住院費用較常規(guī)顯露組高,兩組平均住院費用分別為2.08±0.33萬元vs.1.70±0.34萬元,差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論在甲狀腺手術(shù)中應(yīng)用IONM顯露RLN與常規(guī)顯露相比,可以降低RLN損傷率,加快手術(shù)進程,減少手術(shù)時間及術(shù)中出血,并減少術(shù)后引流量,提前拔管時間,減少住院時間,有利于術(shù)后恢復(fù);在甲狀腺手術(shù)中應(yīng)用IONM費用較高,但患者一般均能接受該費用,從費用效益比考慮我們認(rèn)為IONM在甲狀腺手術(shù)中有較大應(yīng)用價值。
[Abstract]:Objective to evaluate the value of nerve monitoring technique (IONM) in thyroid surgery. Methods 445 patients who underwent thyroid surgery in the first affiliated Hospital of Guangxi Medical University from August 2015 to October 2016 with normal preoperative electronic laryngoscopy were collected. Nerve monitoring technique was used to monitor recurrent laryngeal nerve in 213 cases. 358 recurrent laryngeal nerves were exposed (nerve monitoring group). 232 cases of recurrent laryngeal nerve and 379 recurrent laryngeal nerve (routine exposure group) were exposed during operation. The difference of temporary recurrent laryngeal nerve injury, permanent recurrent laryngeal nerve injury, operation time, intraoperative blood loss, postoperative drainage, extubation time, hospital stay and hospitalization cost were compared between the two groups. Results the rate of temporary RLN damage in the nerve monitoring group was lower than that in the conventional exposure group, and the damage rate of temporary RLN was 1.40 vs.5.28.The difference was statistically significant (P0.05). The permanent RLN damage rate in the nerve monitoring group was also lower than that in the conventional exposure group. There was no significant difference between the two groups (P0.05). The time of operation, blood loss, drainage, extubation and hospital stay were less in the nerve monitoring group than in the conventional exposure group. The mean operative time of the two groups was 163.71 鹵79.26 min vs.192.62 鹵100.60 minutes, the difference was statistically significant (P0.05), the mean intraoperative bleeding volume of the two groups was 36.77 鹵29.85 ml vs.57.41 鹵29.95 ml, respectively (P0.05); the mean postoperative drainage volume of the two groups was 59.81 鹵53.49 ml vs.89.80 鹵70.39 ml, respectively. The mean extubation time was 2.16 鹵1.31d vs.3.16 鹵1.18d in the two groups (P0.05), and the average hospitalization time was 7.60d 鹵2.24d vs.8.22 鹵2.12d in the two groups (P0.05). The average hospitalization cost of the nerve monitoring group was 2.08 鹵3300 vs.1.70 鹵3400 yuan, which was significantly higher than that of the conventional exposure group (P0.05). Conclusion IONM exposure of RLN in thyroid surgery can reduce the rate of RLN injury, speed up the process of operation, reduce the operative time and bleeding, reduce the drainage, remove the tube in advance, and reduce the hospital stay. The cost of using IONM in thyroid surgery is high, but the patients can generally accept the cost. We think that IONM has a great value in thyroid surgery from the cost-benefit ratio.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R653

【參考文獻】

相關(guān)期刊論文 前10條

1 李力農(nóng);趙漢鵬;朱錦騰;馬騰飛;沈益君;林介賢;;胸乳入路腔鏡甲狀腺手術(shù)與傳統(tǒng)手術(shù)治療甲狀腺疾病的優(yōu)劣分析[J];中國當(dāng)代醫(yī)藥;2017年01期

2 蘇慶長;張桂華;孫善平;解磐磐;章陽;;喉返神經(jīng)監(jiān)測技術(shù)在分化型甲狀腺癌中央?yún)^(qū)淋巴結(jié)清掃術(shù)中的臨床應(yīng)用[J];中華普通外科學(xué)文獻(電子版);2016年06期

3 劉昆鵬;代文杰;;甲狀腺再次手術(shù)中喉返神經(jīng)實時監(jiān)測與常規(guī)顯露臨床對比研究[J];中國實用外科雜志;2016年12期

4 王勇;王平;俞星;;甲狀腺手術(shù)中迷走神經(jīng)顯露及喉返神經(jīng)的持續(xù)性術(shù)中神經(jīng)監(jiān)測[J];中華外科雜志;2016年11期

5 殷德濤;李紅強;王勇飛;柳楨;賈勐;張亞原;韓樝;;術(shù)中神經(jīng)監(jiān)測技術(shù)在保護非返性喉返神經(jīng)中的應(yīng)用[J];中華內(nèi)分泌外科雜志;2016年04期

6 柳麓];王培松;王碩;薛帥;陳光;;非返性喉返神經(jīng)解剖特征及術(shù)中保護策略(附22例報告)[J];中國實用外科雜志;2016年08期

7 胡麗萍;王暉;史永照;李學(xué)慶;高斌;程志儉;;腔鏡輔助下巨大甲狀腺腫物手術(shù)中喉返神經(jīng)監(jiān)測的臨床效果分析[J];中國普外基礎(chǔ)與臨床雜志;2016年05期

8 劉勇軍;石朋飛;胡波;張曉毅;江學(xué)慶;;術(shù)中喉返神經(jīng)監(jiān)測在甲狀腺癌再次手術(shù)中的應(yīng)用價值[J];中國普通外科雜志;2016年05期

9 吳嘉瑜;黎洪浩;龍淼云;羅定遠;黃楷;彭新治;黃明清;林少建;朱s，

本文編號：2157884