摘要
目的探索甲状腺二次手术喉返神经损伤的危险因素。方法回顾性分析2016年1月-2019年1月哈尔滨医科大学附属第一医院普外科收治的316例甲状腺二次手术患者临床资料,根据二次术后是否发生喉返神经损伤分为损伤组(n=20)和对照组(n=296),采用统计软件SPSS 23.0进行单因素分析及多因素回归分析。结果甲状腺二次手术喉返神经总损伤率为6.33%(20/316)。其中,单因素分析显示在甲状腺大小、首次术式、两次手术间隔时间、肿瘤侵袭性、二次术式和是否神经监测中喉返神经损伤率升高有统计学意义(χ^2值分别为1.495、1.503、1.628、1.299、1.938、1.262,P<0.05)。Logistic回归分析显示,甲状腺大小(OR=4.962,P=0.001)、首次术式(OR=12.296,P=0.002)、两次手术间隔时间(OR=3.590,P=0.025)和二次术式(OR=2.319,P=0.002)是甲状腺二次手术喉返神经损伤的独立危险因素。结论甲状腺二次手术容易造成喉返神经损伤,对于术前评估存在较高复发风险的甲状腺疾病,首次手术宜选择甲状腺全切除术以根除所有病变以避免二次手术所带来的并发症风险;对于一些高危复杂的二次手术患者,术中使用喉返神经监测技术能够最大程度减少喉返神经损伤、提高患者术后生活质量。
Objective Exploring the risk factors of recurrent laryngeal nerve injury in thyroid surgery.Methods The hundred and sixteen patients undergoing secondary thyroid surgery from January 2016 to January 2019 were selected in the general surgery department of the First Affiliated Hospital of Harbin Medical University.The patients were divided into an injury group(n=20)and a control group(n=296)according to whether the recurrent laryngeal nerve injury occurred after the secondary operation.SPSS 23.0 was used to perform univariate analysis and multivariate regression analysis.Results The total injury rate of recurrent laryngeal nerve in secondary thyroid surgery was 6.33%(20/316).In the univariate analysis,the size of the thyroid,the first operation,the interval between two operations,the tumor aggressiveness,the secondary operation,and whether nerve monitoringa were statistically significant in the injury group and the control group(χ^2=1.495,1.503,1.628,1.299,1.938,1.262,P<0.05).Logistic regression analysis showed that the size of the thyroid gland(OR=4.962,P=0.001),the first operation(OR=12.296,P=0.002),the interval between two operations(OR=3.590,P=0.025)and the secondary operation(OR=2.319,P=0.002)were an independent risk factors for recurrent laryngeal nerve injury in secondary thyroid surgery.Conclusions Secondary thyroid surgery is more likely to cause recurrent laryngeal nerve damage.For the thyroid disease with a high risk of recurrence,total thyroidectomy should be selected for the first surgery to to avoid the risk of complications caused by secondary surgery;For some complicated secondary surgery patients,the use of recurrent laryngeal nerve monitoring technology during operation can minimize the recurrent laryngeal nerve injury and improve the patient′s postoperative quality of life.
作者
李智勇
衣荟洁
李正天
李爱东
Li Zhiyong;Yi Huijie;Li Zhengtian;Li Aidong(Department of Endoscopic Surgery,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)
出处
《国际外科学杂志》
2020年第8期555-559,共5页
International Journal of Surgery
关键词
甲状腺肿瘤
复发
外科手术
喉返神经
危险因素
Thyroid tumor
Recurrence
Surgery
Recurrent laryngeal nerve
Risk factors
