【摘要】：目的:本研究主要是對比了用與不用喉返神經監(jiān)測儀在治療甲狀腺癌二次手術淋巴結清掃術方面的效果。主要是研究了喉返神經監(jiān)測在甲狀腺癌二次手術中的使用情況,分析了此種辨認辦法對喉返神經的識別,觀察了左側甲狀腺癌和右側甲狀腺癌分別的手術時間以及手術處置期間的出血量、引流量和淋巴結的掃除數量,同時對比了應用喉返神經監(jiān)測儀時左、右側喉返神經在手術中的分離時間、損傷率等方面的差異,以便為臨床研究提供一定的參考作用,同時還探討了這種技術在淋巴結清除術中的使用意義,為其進一步擴大應用領域和手術應用起到一定促進作用。方法:本研究選擇我院2015年1月到2016年12月期間收治的84例單側甲狀腺癌二次手術患者,左側31例,右側53例,將其分為兩組,也即使用喉返神經監(jiān)測儀組(IONM組)和非使用喉返神經監(jiān)測儀組(非IONM組),前一組為42例,在手術中用喉返神經監(jiān)測儀來查驗、分離喉返神經,后一組42例,在處置期間用通常的暴露法肉眼直視分離喉返神經。術中、術后分別采集總的及IONM組左、右側喉返神經分別的手術時間、出血量,聲帶受損情況。術后三天中每天的引流量,以及術后1天、術后1周、術后3月的聲帶運動情況。結果:左側甲狀腺癌、右側甲狀腺癌二次手術IONM組所用時間明顯小于非IONM組(57.0±5.2和61.2±5.7分鐘,P0.05;59.6±6.8和65.4±5.9,P0.05);平均在手術處置期間出血量兩組差異不明顯(10.6±3.4和12.7±4.2ml,P0.05;11.3.±4.5,12.7±5.6,P0.05);左側甲狀腺癌、右側甲狀腺癌手術處置后1、2、3天引流量IONM組均明顯小于非IONM組(P0.05);術后1天聲帶運動異常IONM組要明顯少于非IONM組(1例,2.3%;6例,14.2%,P0.05);術后1周聲帶運動異常IONM組明顯少于非IONM組(0例,0%;4例,9.5%,P0.05);術后3月聲帶運動異常IONM組0例,非IONM組1例;IONM組左側喉返神經所需要的分離時間明顯少于右側喉返神經分離時間(10.6±2.6min和16.5±3.2min,P0.05),但兩者的損傷率無顯著差異,(0%和4.5%,P0.05)。結論:本研究結果表明,利用喉返神經檢測儀在進行甲狀腺癌二次手術淋巴結清除術時具有一定優(yōu)勢,可以有效減少手術時間、引流量,同時可減少喉返神經損傷率,對術后恢復也有一定積極作用,同時會對喉返神經有保護作用,能有效的上升外科治療后生活質量,不過在控制術中出血量和清除淋巴結數量方面沒有顯示出作用。IONM組左側喉返神經比右側喉返神經分離時間短,但兩者的喉返神經損傷率無顯著差異。這種檢測會增加一部分治療成本,因此在治療甲狀腺癌時,能夠綜合考慮適當選擇應用喉返神經檢測儀。
[Abstract]:Aim: the purpose of this study was to compare the effect of recurrent laryngeal nerve monitor (RLN) with or without recurrent laryngeal nerve (RLN) in the treatment of thyroid carcinoma by lymph node dissection. The main purpose of this paper is to study the use of recurrent laryngeal nerve monitoring in the secondary operation of thyroid cancer, and analyze the recognition of the recurrent laryngeal nerve by this method. The operation time of left thyroid cancer and right thyroid carcinoma were observed, and the amount of bleeding, drainage flow and the number of lymph node dissection were observed during the operation. Meanwhile, the left side was compared with the left side when using the recurrent laryngeal nerve monitor. The differences in separation time and injury rate of the right recurrent laryngeal nerve during operation are different in order to provide a certain reference for clinical study, and the significance of this technique in lymph node dissection is also discussed. It plays an important role in further expanding its application field and surgical application. Methods: from January 2015 to December 2016, 84 patients with unilateral thyroid carcinoma were divided into two groups: left side (31 cases) and right side (53 cases). Even if the recurrent laryngeal nerve monitor group (IONM group) and the non-use recurrent laryngeal nerve monitor group (non-IONM group), the former group of 42 cases, using the recurrent laryngeal nerve monitoring instrument to examine during the operation, separation of the recurrent laryngeal nerve, the latter 42 cases, The recurrent laryngeal nerve (RLN) was separated directly from the laryngeal nerve with the normal exposure method during the treatment. The operation time, bleeding volume and vocal cord damage of the left and right recurrent laryngeal nerves in the IONM group and the total group were collected after operation. Daily drainage and vocal cord movement 1 day, 1 week and 3 months after operation. Results: the time of second operation of left thyroid carcinoma and right thyroid carcinoma in IONM group was significantly shorter than that in non-IONM group (57.0 鹵5.2,61.2 鹵5.7min, P 0.05 鹵6.8,65.4 鹵5.9, P0.05). There was no significant difference in blood loss between the two groups (10.6 鹵3.4,12.7 鹵4.2 ml, P 0.05 鹵11.3 鹵4.5, 12.7 鹵5.6, P0.05). The drainage flow in IONM group was significantly lower than that in non-IONM group on the 1st, 2nd and 3rd day after surgical management of left thyroid carcinoma and right thyroid carcinoma (P0.05), and the vocal cord movement abnormality in IONM group was significantly less than that in non-IONM group on the 1st day after operation (2.3%). 6 cases (14.2%, P0.05), 1 week after operation, the vocal cord movement abnormality in IONM group was significantly lower than that in non-IONM group (0 cases, 0%, 4 cases, 9.5%, P0.05), 3 months after operation, there were 0 cases in IONM group and 1 case in non-IONM group. The separation time of left recurrent laryngeal nerve in the IONM group was significantly shorter than that in the right recurrent laryngeal nerve (10.6 鹵2.6min vs 16.5 鹵3.2 min, P0.05), but there was no significant difference in the injury rate between the two groups (0% and 4.5%, P0.05). Conclusion: the results of this study show that the RLN detector has some advantages in the second operation of thyroid carcinoma. It can effectively reduce the operation time and drainage volume, and reduce the rate of recurrent laryngeal nerve injury at the same time. It also has a positive effect on postoperative recovery, and also has a protective effect on the recurrent laryngeal nerve, which can effectively improve the quality of life after surgical treatment. In the IONM group, the separation time of the left recurrent laryngeal nerve was shorter than that of the right recurrent laryngeal nerve, but there was no significant difference in the injury rate of the RLN between the IONM group and the right RLN group. This test will increase some of the cost of treatment, so when treating thyroid cancer, it is possible to consider the proper choice of RLN detector in the treatment of thyroid cancer.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R736.1

【參考文獻】

相關期刊論文 前10條

1 連軍勝;李玉杰;趙春紅;;不同類型單側喉返神經損傷患者神經肌電變化特征分析[J];中國實用神經疾病雜志;2015年15期

2 李發(fā)榮;張阿龍;陶立;李振毅;;甲狀腺切除術中探查喉返神經的臨床價值[J];寧夏醫(yī)學雜志;2015年08期

3 李朋;崔軍威;劉巧劌;于志強;韋偉;;45條喉返神經喉外分支變異手術體會[J];腫瘤學雜志;2015年06期

4 王曉俠;姚小寶;李宏慧;白艷霞;張少強;申震;;甲狀腺再手術中喉返神經尋找方法初探[J];臨床耳鼻咽喉頭頸外科雜志;2015年11期

5 邵堂雷;王振乾;蔣曉;黃河;伍承天;吳志浩;丁昊;殷佳晗;楊衛(wèi)平;;甲狀腺再次手術中喉返神經保護研究(附163例分析)[J];中國實用外科雜志;2015年06期

6 胡長軍;張明敏;郭永忠;王鵬;丁木拉提;克依木;肖克來提;黃偉;趙鷹;;腔鏡甲狀腺手術中喉返神經的解剖特點[J];中國微創(chuàng)外科雜志;2015年05期

7 郭滿;張浩;李偉漢;高金亮;楊靜;;納米碳在cN_0期甲狀腺癌手術中對甲狀旁腺及喉返神經的保護作用研究[J];中國醫(yī)學工程;2015年04期

8 李海鵬;劉新洪;魏福國;張建立;呂斌;陳波;;術中喉返神經監(jiān)測技術在完全腔鏡甲狀腺手術中的應用研究[J];腹腔鏡外科雜志;2015年04期

9 姜敏炎;呂亞軍;黃駿;朱小波;蔣鋒;吳偉敏;;微創(chuàng)食管癌切除術右喉返神經旁淋巴結清掃150例[J];實用醫(yī)學雜志;2015年04期

10 劉n，

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