Yan Shouyi, Xie Chao, Zhao Wenxin, Wang Bo, Zhang Liyong
Department of Thyroid and Vascular Surgery.
Department of General Surgery.
Medicine (Baltimore). 2020 May;99(19):e20138. doi: 10.1097/MD.0000000000020138.
More surgeons have known the importance of parathyroid grand and recurrent laryngeal nerve protection in the surgery, but there is still plenty of scope to improve the surgical techniques. This study aims at investigating whether the improved method of finding recurrent laryngeal nerve (RLN) can protect parathyroid grand and RLN.
One hundred fifty-eight patients were enrolled and divided randomly into the test and control group according to different methods of finding RLN in the surgery. In the experimental group the author could quickly find the laryngeal recurrent nerve in the lower part of the neck and separate along the surface of the recurrent laryngeal nerve to the point where the recurrent laryngeal nerve gets into the larynx close to the thyroid gland named lateral approach, while in the control group the author severed the middle and lower thyroid vein and raised the lower thyroid pole to look for the RLN near the trachea by the blunt separation.
The author identified 152 and 159 parathyroid glands in the test and control group, respectively and there were a lower ratio of auto-transplantation and less operative time in the test group compared with that in the control group. The author also found that the parathyroid hormone level (1 day and 2 months) in the test group was higher than that in the control group. There were no differences in metastatic LN and recurrent laryngeal nerve palsy in the 2 groups.
The improved method of finding RLN is a simple, efficient and safe way, and easy to implement.
越来越多的外科医生已经认识到在手术中保护甲状旁腺和喉返神经的重要性,但手术技术仍有很大的改进空间。本研究旨在探讨改进的喉返神经(RLN)寻找方法是否能保护甲状旁腺和喉返神经。
纳入158例患者,根据手术中寻找RLN的不同方法随机分为试验组和对照组。试验组作者能在颈部下方快速找到喉返神经,并沿喉返神经表面分离至喉返神经进入甲状腺附近喉部的位置,即外侧入路;而对照组作者切断甲状腺中、下静脉,抬起甲状腺下极,通过钝性分离在气管附近寻找RLN。
试验组和对照组分别识别出152个和159个甲状旁腺,试验组自体移植率较低,手术时间较短。作者还发现试验组甲状旁腺激素水平(术后1天和2个月)高于对照组。两组在淋巴结转移和喉返神经麻痹方面无差异。
改进的RLN寻找方法简单、高效、安全,且易于实施。