摘要
目的 探讨神经监测技术在甲状腺全切术及中央区淋巴结清扫术中的应用效果.方法 回顾性分析2017年1月至2023年1月在贵州航天医院行甲状腺全切术的100例甲状腺肿瘤患者为研究对象,按照术中是否使用神经探测分为观察组和常规显露组,每组各50例.观察组术中实施喉返神经监测技术,常规显露组术中常规显露喉返神经.记录两组手术指标(手术时间、术中出血量、引流管拔管时间和术后住院时间),比较两组手术前后的简化嗓音障碍指数(VHI-10)评分、声带功能指标、血清甲状旁腺素、钙水平及永久性喉返神经损伤发生率、暂时性喉返神经损伤发生率.结果 两组手术时间、术中出血量、引流管拔管时间和术后住院时间比较,差异均无统计学意义(P＞0.05).观察组术后VHI-10评分为(1.18±0.38)分,低于常规显露组[(1.97±0.61)分],差异有统计学意义(P＜0.05).观察组术后谐波噪声比为(25.61±6.07)dB,高于常规显露组[(19.07±4.53)dB],振幅微扰、基频微扰和基频分别为(1.67±0.22)％、(0.20±0.04)％、(132.36±14.23)Hz,均低于常规显露组[(1.67±0.22)％、(0.20±0.04)％、(132.36±14.23)Hz],差异均有统计学意义(P＜0.05).观察组术后血清甲状旁腺素、钙水平分别为(32.46±4.82)μg/L、(2.08±0.48)mmol/L,均高于常规显露组[(18.79±3.05)μg/L、(1.85±0.22)mmol/L],差异均有统计学意义(P＜0.05).观察组暂时性喉返神经损伤发生率为0,低于常规显露组(8.00％),差异有统计学意义(P＜0.05),永久性喉返神经损伤发生率比较,差异无统计学意义(P＞0.05).结论 神经探测在甲状腺全切术及中央区淋巴结清扫术中的应用效果确切,能够有效改善嗓音及声带功能,保护喉返神经,减少暂时性喉返神经损伤发生,应用价值较高.
Abstract
Objective To investigate the effect of neural monitoring technology in total thyroidectomy and central lymph node dissection.Methods One hundred patients with thyroid tumors who underwent total thyroidectomy in Guizhou Aerospace Hospital from January 2017 to Janu-ary 2023 were retrospectively analyzed,and divided into the observation group and the conventional exposure group according to whether neural mo-nitoring technology,with 50 cases in each group.The observation group implemented recurrent laryngeal neural monitoring technology during sur-gery,while the conventional exposure group underwent intraoperative routine exposure of the recurrent laryngeal nerve.The surgical indexes(oper-ation time,intraoperative blood loss,drainage tube removal time,and postoperative hospital stay)of the two groups were recorded,and the simpli-fied Voice Handicap Index(VHI-10)scores,vocal fold function indexes,serum parathyroid hormone,calcium levels,and the incidence of per-manent laryngeal recurrent nerve injury and temporary laryngeal recurrent nerve injury were compared before and after the surgery in both groups.Results There were no statistically significant differences between the two groups in terms of operation time,intraoperative blood loss,drainage tube removal time,and postoperative hospital stay(P＞0.05).The VHI-10 score of the observation group after surgery was(1.18±0.38)points,which was lower than that of the conventional exposure group[(1.97±0.61)points],and the difference was statistically significant(P＜0.05).The harmonic noise ratio of the observation group after surgery was(25.61±6.07)dB,which was higher than that of the conventional exposure group[(19.07±4.53)dB],the amplitude perturbation,fundamental frequency perturbation,and fundamental frequency perturbation were(1.67±0.22)％,(0.20±0.04)％,and(132.36±14.23)Hz,respectively,which were all lower than those of the conventional expo-sure group[(1.67±0.22)％,(0.20±0.04)％,and(132.36±14.23)Hz],and the differences were statistically significant(P＜0.05).The levels of serum parathyroid hormone and calcium in the observation group were(32.46±4.82)μg/L,(2.08±0.48)mmol/L,respective-ly,which were higher than those in the conventional exposure group[(18.79±3.05)]μg/L,(1.85±0.22)mmol/L],the differences were statistically significant(P＜0.05).The incidence of temporary recurrent laryngeal nerve injury in observation group was 0,which was lower than that in conventional exposure group(8.00％),the difference was statistically significant(P＜0.05),and there was no statistically significant difference in the incidence of permanent recurrent laryngeal nerve injury(P＞0.05).Conclusion Neural monitoring technology can effectively improve voice and vocal cord function,protect recurrent laryngeal nerve and reduce temporary recurrent laryngeal nerve injury.It has high applica-tion value and is worthy of clinical promotion.
基金项目
贵州省卫生健康委科学技术基金项目(gzwkj2022-342)
NETL
NSTL
万方数据