Shi Q, Fang J G, Zhong Q, Chen X, Feng L, Hou L Z, Ma H Z, He S Z, Wang R, Yang Y F, Chen J M, Xu J Q
Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing 100730, China.
Zhonghua Yi Xue Za Zhi. 2023 Oct 31;103(40):3180-3185. doi: 10.3760/cma.j.cn112137-20230619-01040.
To investigate the application and effect of capillary fascia preservation between the recurrent laryngeal nerve (RLN) and common carotid artery (fascia preservation method) in nerve protection when dissecting right level Ⅵ lymph nodes for patients with papillary thyroid carcinoma. A retrospective cohort study enrolling 195 patients with papillary thyroid carcinoma undergoing right level Ⅵ lymph node dissection in Beijing Tongren Hospital from March 2021 to August 2022 was carried out. The RLN was dissected by fascia preservation method in study group and by routine method in control group. The intraoperative electrical signal amplitude of the RLN, the number of dissected lymph nodes, and the postoperative complications were recorded and analyzed. A total of 195 patients (study group: 94 cases, control group: 101 cases) were collected. There were 71 males and 124 females, with the median age of 32 (39, 51) years. In the study group, the total number of right level Ⅵ lymph nodes was significantly larger than the number of right Ⅵa level lymph nodes [8 (6, 11) vs 6 (4, 8), <0.001]. There were no significant differences between the two groups in the number of level Ⅵa or level Ⅵb lymph nodes [Ⅵa: 6 (4, 8) vs 5 (3, 7), =0.373; Ⅵb: 3 (1, 4) vs 2 (1, 4), =0.337] and metastasis rate [Ⅵa: 51.1% (48/94) vs 52.5% (53/101), =0.844; Ⅵb: 12.8% (12/94) vs 15.8% (16/101), =0.541]. The ratio of electromyography (EMG) amplitude R2 in lower level Ⅵ and entry into larynx (grouped as>90%, 50%~90%,<50%) in the study group was significantly higher than that in the control group (<0.001). No significant differences were detected between the two groups in temporary RLN paralysis [1.1% (1/94) vs 2.0% (2/101), =1.000]. Fascia preservation method can decrease the stimulus and traction to RLN and preserve the capillary network serving RLN. It can thoroughly dissect lymph nodes and decrease the injury of RLN.
探讨在甲状腺乳头状癌患者右侧Ⅵ区淋巴结清扫术中，喉返神经（RLN）与颈总动脉之间保留毛细血管筋膜（筋膜保留法）在神经保护中的应用及效果。对2021年3月至2022年8月在北京同仁医院接受右侧Ⅵ区淋巴结清扫术的195例甲状腺乳头状癌患者进行回顾性队列研究。研究组采用筋膜保留法解剖RLN，对照组采用常规方法。记录并分析RLN术中电信号幅度、清扫淋巴结数量及术后并发症。共收集195例患者（研究组：94例，对照组：101例）。其中男性71例，女性124例，年龄中位数为32（39，51）岁。研究组右侧Ⅵ区淋巴结总数明显多于右侧Ⅵa区淋巴结数[8（6，11）对6（4，8），<0.001]。两组在Ⅵa区或Ⅵb区淋巴结数量[Ⅵa：6（4，8）对5（3，7），=0.373；Ⅵb：3（1，4）对2（1，4），=0.337]及转移率[Ⅵa：51.1%（48/94）对52.5%（53/101），=0.844；Ⅵb：12.8%（12/94）对15.8%（16/101），=0.541]方面差异无统计学意义。研究组Ⅵ区低位与入喉处肌电图（EMG）幅度R2比值（分为>90%、50%~90%、<50%）明显高于对照组（<0.001）。两组在RLN暂时性麻痹方面差异无统计学意义[1.1%（1/94）对2.0%（2/101），=1.000]。筋膜保留法可减少对RLN的刺激和牵拉，保留为RLN供血的毛细血管网，能彻底清扫淋巴结并减少RLN损伤。
