摘要
目的探讨解剖暴露喉返神经术在甲状腺叶切除术中的临床意义。方法将2010年3月至2013年3月重庆市长寿区人民医院收治的200例甲状腺病变患者依据随机数字表法分为对照组和观察组,各100例。对照组术中不暴露喉返神经,观察组术中解剖暴露喉返神经,对两组患者进行为期6个月的随访。对比两组患者的首日引流量、术中出血量、手术时间、手术皮瓣的面积、甲状旁腺功能、胶质细胞源性神经营养因子(GDNF)水平。结果观察组甲状旁腺受损率低于对照组[0.0%(0/100)比5.0%(5/100)],观察组随访3个月和半年的喉返神经损伤率低于对照组[0.0%(0/100)比3.0%(3/100),8.0%(8/100)比12.0%(12/100)],差异有统计学意义(P<0.05)。观察组术后皮瓣面积、手术时间、术中出血量、住院时间、术后首日引流量均少于对照组[(123±11)cm2比(146±27)cm2,(64±7)min比(68±11)min,(8±3)m L比(56±13)m L,(8.4±1.3)d比(14.5±1.9)d,(130±5)m L比(180±7)m L],差异有统计学意义(P<0.01)。术前两组患者血清GDNF水平差异无统计学意义(P>0.05),术后出现喉返神经损伤患者GDNF水平下降,随访至3个月时观察组患者GDNF水平显著高于对照组(P<0.05),随访6个月后,观察组GDNF值基本恢复至术前水平,但对照组GDNF明显较低(P<0.05)。结论甲状腺术中解剖暴露喉返神经有利于保护喉返神经,GDNF可能成为甲状腺叶切除术后检测喉返神经功能的生物学指标,有望成为治疗喉返神经损伤的靶方向。
Objective To discuss the clinical significance of the surgical exposure of recurrent laryngeal nerve in thyroid lobectomy. Methods Total of 200 patients with thyroid disease admitted to Changshou District People＇s Hospital from Mar. 2010 to Mar. 2013 were included and divided into a control group of 100 cases,and an observation group of 100 cases according to the random number table method： in the control group,there was no recurrent laryngeal nerve exposure procedure during the surgery; in the observation group there was recurrent laryngeal nerve exposure procedure during the surgery,then a six-month follow-up was done for both groups. The first day drainage amount,intraoperative blood loss,operative time,surgical flap area,parathyroid function,glial cell line-derived neurotrophic factor（ GDNF） levels of the two groups were compared. Results Parathyroid damage rate in the observation group was lower than the control group[0. 0%（ 0 /100） vs 5. 0%（ 5 /100） ],the three months and six months recurrent laryngeal nerve injury rate of the observation group were lower than the control group[0. 0%（ 0 /100） vs 3. 0%（ 3 /100）,8. 0%（ 8 /100） vs 12. 0%（ 12 /100） ],the differences weres statistically significant（ P〈0. 05）. Flaps area,operative time,blood loss,hospital stay,postoperative drainage volume on the first day of the observation group were less than the control group[（ 123 ± 11） cm2vs（ 146 ± 27） cm2,（ 64 ± 7） min vs（ 68 ± 11） min,（ 8 ±3） m L vs（ 56 ± 13） m L,（ 8. 4 ± 1. 3） d vs（ 14. 5 ± 1. 9） d,（ 130 ± 5） m L vs（ 180 ± 7） m L],the differences were statistically significant（ P〈0. 01）. The preoperative serum GDNF levels of the two were similar（ P〉0. 05）,while the postoperative GDNF level of patients with recurrent laryngeal nerve injury was decreased,by three months after surgery,GDNF level of the observation group was significantly higher than the control group（ P〈0. 05）,to six months after surgery,GDNF level of t
出处
《医学综述》
2016年第11期2271-2273,共3页
Medical Recapitulate
关键词
甲状腺叶切除术
喉返神经
解剖暴露
胶质细胞源性神经营养因子
Thyroid lobectomy
Recurrent laryngeal nerve
Anatomical exposure
Glial cell line derived neurotrophic factor
