甲状腺癌手术喉返神经损伤的影响因素分析及预防

Influencing factors and preventive measures for recurrent laryngeal nerve injury in thyroid cancer surgery

摘要:

目的 分析甲状腺癌喉返神经（RLN）损伤影响因素并建立预防措施。方法 以2018年1月-2019年12月诊治的420例甲状腺癌手术患者为研究对象，采用Logistic回归分析患者甲状腺癌病理类型，TNM分期、手术方式、肿瘤部位、神经暴露的关系等因素对RLN损伤发生率的影响，并建立相应预防措施。结果 420例甲状腺癌患者，术后有25例患者发生RLN损伤，发生率为5.95%；其中永久性损伤10例（2.38%），暂时性损伤15例（3.57%）；术后随访1年，10例永久性损伤患者功能未恢复，15例暂时性损伤患者声带运动均在6个月内恢复。甲状腺癌手术患者RLN损伤单因素分析显示，发生RLN损伤率与肿瘤部位、手术方式、手术次数有关（P<0.05）；多因素Logistic回归分析显示，肿瘤部位、手术方式、手术次数是RLN损伤发生的独立危险因素（P<0.05）。结论 肿瘤部位、手术方式、手术次数是RLN损伤发生的独立危险因素，熟悉RLN解剖结构、暴露神经可作为降低RLN发生的预防措施。

Abstract:

Objective To analyze the influencing factors and preventive measures for recurrent laryngeal nerve (RLN) injury in thyroid cancer surgery.Methods Taking 420 patients undergoing thyroid cancer surgery in our hospital from Jan 2018 to Dec 2019 as the research objects, logistic regression was used to analyze the relationships between the pathological type of thyroid cancer, TNM staging, surgical method, tumor location, and nerve exposure, and their impacts on the occurrence rate of RLN injury. And corresponding preventive measures were established.Results Among 420 patients with thyroid cancer, 25 patients developed RLN injury after operation with an incidence rate of 5.95%. The RLN injury was permanent in 10 cases (2.38%) and temporary in 15 (3.57%). Postoperative follow-up for 1 year revealed no recovery of RLN function in the 10 cases with permanent injury and complete recovery of vocal cord movement in the 15 with temporary injury within 6 months. Univariate analysis showed that the incidence of RLN injury was associated with tumor location, operation method, and times of operation (all P<0.05). Multivariate logical regression analysis indicated that tumor location, operation method, and times of operation were independent risk factors for RLN injury (all P<0.05).Conclusions Tumor location, operation method, and times of operation are independent risk factors for RLN injury in thyroid cancer surgery. Familiarity with the anatomy of RLN and adequate exposure of nerves are the preventive measures to reduce the occurrence of RLN injury.