摘要
目的:探讨非能量器械联合喉返神经监测在胸腔镜下肺癌根治术中保护喉返神经的可行性及安全性。方法:选取2020年3月至2022年4月于我院行单孔胸腔镜下肺癌根治术的非小细胞肺癌患者206例作为研究对象,分为使用能量器械清扫喉返神经相关淋巴结的能量组和使用非能量器械并进行术中喉返神经监测的非能量监测组。回顾性分析两组患者的术中及术后情况。采用单变量分析和多变量分析来寻找喉返神经损伤的风险因素。结果:所有患者均顺利完成手术,无围术期死亡。喉返神经相关淋巴结的总转移率为6.96%(38/546)。能量组患者的手术时间明显短于非能量监测组(140 min vs 150 min,Z=-3.071,P=0.002),术后第一天引流量明显少于非能量组(170 mL vs 210 mL,Z=-2.017,P=0.044),但非能量监测组患者的喉返神经损伤明显少于能量组(7.48%vs 17.17%,χ^(2)=4.533,P=0.033),且非能量监测组的患者更有可能从喉返神经损伤中恢复(P=0.022)。体质指数(OR=1.228,95%CI:1.030~1.465,P=0.022)、肿瘤的解剖学分型(OR=0.079,95%CI:0.022~0.285,P<0.001)、肿瘤原发侧(OR=3.613,95%CI:1.130~11.550,P=0.030)和手术器械(OR=5.237,95%CI:1.686~16.266,P=0.004)是喉返神经损伤的独立风险因素。结论:体质指数、肿瘤的解剖学分型、肿瘤原发侧和手术器械是喉返神经损伤的独立风险因素。在单孔胸腔镜下肺癌根治术清扫喉返神经相关淋巴结时联合使用非能量器械和术中喉返神经监测可能有助于降低喉返神经损伤的发生率,并提高恢复率。
Objective:To explore the feasibility and safety of non-energy devices and recurrent laryngeal nerve(RLN)monitoring during thoracoscopic radical resection of lung cancer for RLN protection.Methods:Two hundred and six non-small cell lung cancer patients who underwent single-hole thoracoscopic radical resection of lung cancer in our hospital from March 2020 to April 2022 were selected as the research subjects,and were assigned to the energy group[dissection of RLN lymph nodes(RLNLNs)with energy devices]and the NE-RLNM group(RLN monitoring with non-energy devices).The intraoperative and postoperative conditions of the two groups were retrospectively analyzed.Univariable and multivariable analyses were used to find the risk factors of RLN injuries.Results:All patients had successfully completed their surgeries and there were no perioperative death.The total metastasis rate of RLNLNs was 6.96%(38/546).The operation time in the energy group was significantly shorter than that in the NE-RLNM group(140 min vs 150 min,Z=-3.071,P=0.002);and chest tube drainage 1 day after surgery in the energy group was significantly less than that in the NE-RLNM group(170 mL vs 210 mL,Z=-2.017,P=0.044).But RLN injuries in the NE-RLNM group were signifcantly less than those in the energy group(7.48%vs 17.17%,χ^(2)=4.533,P=0.033).Patients in the NE-RLNM group were more likely to recover from RLN injuries(P=0.022).Body mass index(OR=1.228,95%CI:1.030~1.465,P=0.022),anatomical classification of primary tumor(OR=0.079,95%CI:0.022~0.285,P=0.001),side of primary tumor(OR=3.613,95%CI:1.130~11.550,P=0.030)and surgical devices(OR=5.237,95%CI:1.686~16.266,P=0.004)were independent risk factors of RLN injuries.Conclusion:Body mass index,anatomical classification of primary tumor,side of primary tumor and surgical devices were independent risk factors of RLN injuries.Application of non-energy devices and RLN monitoring during single-hole thoracoscopic radical resection of lung cancer and dissection of RLNLNs might help decrease the incidence of RLN inj
作者
刘蔡杨
冉冉
李晓亮
罗雷
邵红
刘高华
王毅
李季
Liu Caiyang;Ran Ran;Li Xiaoliang;Luo Lei;Shao Hong;Liu Gaohua;Wang Yi;Li Ji(Department of Cardiothoracic Surgery,the First People's Hospital of Neijiang,Neijiang 641000,Sichuan,China;Department of Breast Surgery,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,Affiliated Cancer Hospital of University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China)
出处
《肿瘤预防与治疗》
2023年第9期778-786,共9页
Journal of Cancer Control And Treatment
基金
内江市重点科学技术项目(编号:Z202142)。
关键词
喉返神经监测
非能量器械
喉返神经保护
非小细胞肺癌
回顾性研究
Recurrent laryngeal nerve monitoring
Non-energy device
Recurrent laryngeal nerve protection
Non-small cell lung cancer
Retrospective study
