目的 探究喉返神经全程显露三步法应用于经胸前入路腔镜甲状腺切除术预防喉返神经暂时性损伤的效果。 方法 回顾性分析2021年7月至2023年7月作者团队运用喉返神经全程显露三步法进行的78例经胸前入路腔镜甲状腺切除术的手术录像以及患者临床资料，观察术中喉返神经全程显露情况，以及术后出现喉返神经损伤症状或其他不良反应。 结果 78例手术均成功完成，无中转开放手术，共全程显露喉返神经117条，术中出血量20~100 mL（平均37.8 mL），术后均未发现声音嘶哑、发声无力或呼吸困难等喉返神经受损表现。 结论 经胸前入路腔镜甲状腺手术中运用喉返神经全程显露三步法有助于保护喉返神经，减少喉返神经热损伤，此方法操作简单，易于掌握，值得临床推广。
Abstract
Objective To investigate the efficacy of applying the three-step method of full laryngeal recurrent nerve visualization to prevent laryngeal recurrent nerve injury during laparoscopic thyroidectomy via anterior chest approach. Methods The 78 surgical videos performed by the author's surgical team, from July 2021 to July 2023, as well as clinical data of the patients were retrospectively analyzed to observe intraoperative full laryngeal recurrent nerve visualization and postoperative occurrence of nerve injury symptoms or other adverse reactions. Results All the 78 surgical operations were successfully completed without intermediate open surgery, and altogether 117 recurrent laryngeal nerves were exposed throughout the operation, with intraoperative bleeding of 20-100 mL (average 37.8 mL). No symptoms of recurrent laryngeal nerve damage, such as hoarseness of voice or dysphagia, were observed in all 78 patients after the operation. Conclusions The three-step method of full laryngeal recurrent nerve visualization in laparoscopic thyroidectomy via anterior chest approach contributes to the protection of the functional integrity of the recurrent laryngeal nerve and reduces the recurrent laryngeal nerve injury by latent heat, and this method can be operated conveniently with easy learning, which is worth to be popularized in the clinic.
关键词
腔镜； /
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甲状腺； /
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喉返神经保护； /
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甲状腺切除术
Key words
Laparoscope; /
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Thyroid; /
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Recurrent laryngeal nerve; /
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Endoscopic thyroidectomy
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参考文献
[1] 田文, 姚京, 郗洪庆, 等. 中国腔镜甲状腺手术20年回顾与展望[J]. 中华普外科手术学杂志(电子版), 2021,15(6): 598-602. DOI: 10.3877/cma.j.issn.1674-3946.2021.06.002.
[2] 王平，项承. 经胸前入路腔镜甲状腺手术专家共识(2017版)[J]. 中国实用外科杂志, 2017, 37(12): 1369-1373. DOI: 10.19538/j.cjps.issn1005-2208.2017.12.14.
[3] Gunn A, Oyekunle T, Stang M, et al. Recurrent laryngeal nerve injury after thyroid surgery: an analysis of 11,370 patients[J]. J Surg Res, 2020, 255(1): 42-49. DOI: 10.1016/j.jss.2020.05.017.
[4] 郭榆江, 吴政龙, 吕夕东, 等. 甲状腺手术中喉返神经损伤的类型和处理[J]. 中国现代手术学杂志, 2015, 19(5): 335-337. DOI: 10.16260/j.cnki.1009-2188.2015.05.003.
[5] Davey MG, Cleere EF, Lowery AJ, et al. Intraoperative recurrent laryngeal nerve monitoring versus visualisation alone-a systematic review and meta-analysis of randomized controlled trials[J]. Am J Surg, 2022, 224(3): 836-841. DOI: 10.1016/j.amjsurg.2022.03.036.
[6] 闫开旭, 刘宏斌. 胸壁入路腔镜甲状腺手术中喉返神经的显露与保护[J]. 中国普外基础与临床杂志, 2016, 23(12): 1510-1512. DOI: 10.7507/1007-9424.20160381.
[7] Shen C, Xiang M, Wu H, et al. Routine exposure of recurrent laryngeal nerve in thyroid surgery can prevent nerve injury[J]. Neural Regene Res, 2013,8(17): 1568-1575. DOI: 10.3969/j.issn.1673-5374. 2013. 17.004.
[8] 胡继盛, 孔瑞, 杨刚, 等. 甲状腺全切除术中显露喉返神经入路随机对照研究[J]. 中国实用外科杂志, 2016, 36(2): 230-233. DOI: 10.7504/CJPS.ISSN1005-2208.2016.02.29.
[9] 焦梦思, 范宁, 石玉琦, 等. 喉返神经入喉处的精细解剖学研究[J]. 中国临床解剖学杂志, 2021, 39(6): 642-645. DOI: 10.13418/j.issn.1001-165x.2021.06.004.
[10]唐诗彬, 陈小伍, 吴路杨, 等. Berry韧带、Zuckerkandl结节及其在腔镜甲状腺腺叶切除术中的意义[J]. 中国临床解剖学杂志, 2013, 31(1): 115-117. DOI: 1001-165X(2013)01-115-03.
[11]刘震, 方向, 刘忠亮, 等. 甲状腺手术中使用超声刀对喉返神经的保护作用研究[J]. 中国医学创新, 2012, 9(20): 44-45. DOI: 10.3969/j.issn.1674-4985.2012.20.026.
[12]陈曦. 甲状腺手术中热损伤预防[J]. 中国实用外科杂志, 2012, 32(5): 369-372. DOI: 1005-2208(2012)05-0369-04.
[13]田文, 张浩. 甲状腺外科能量器械应用专家共识(2017版)[J]. 中国实用外科杂志, 2017, 37(9): 992-997. DOI: 10.19538/j.cjps.issn1005-2208.2017.09.14.
基金
广东省科学技术厅“海外名师”项目；南方医科大学第三附属医院院长基金面上项目（YM202208）
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