Abstract:

Approaches of exposing recurrent laryngeal nerve in total thyroidectomy: A randomized controlled study                   HU Ji-sheng，KONG Rui，YANG Gang，et al. Department of Pancreatic and Biliary Surgery，the First Affiliated Hospital，Harbin Medical University，Harbin 150001，China  
Corresponding author：WU Lin-feng，E-mail: wulinfeng1020@126.com
Abstract    Objective    To investigate the clinical effect of three surgical approaches (entering point approach， tracheoesophageal groove approach，inferior thyroid artery approach）to exposure of recurrent laryngeal nerve (RLN) in total thyroidectomy. Methods    A randomnized, prospective study was conducted among 286 patients who were confirmed diagnosed or highly suspected with malignant thyroid diseases, bilateral multinodular goiter, toxic multinodular goiter and Graves disease. All patients were performed thyroidectomy totally from March 2014 to March 2015 in Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University. The enrolled patients were randomly divided into three groups, Group A (entering point of RLN approach, n=97), Group B (tracheoesophageal groove approach, n=96) and Group C (inferior thyroid artery approach, n=93). The postoperative effects were compared among three groups. Results    There was no statistical difference in RLN injury (Group A vs. Group B vs. Group C: 1.0% vs. 2.1% vs. 5.4%，P =0.158) and postoperative hospital stay [（2.6±0.5）d vs. （2.5±0.7）d vs. （2.6±0.5）d，F=0.724，P=0.486）]among three groups. The volume of blood loss of Group A and B was less than Group C [（10.1±7.2）mL vs.（12.0±10.0）mL vs.（8.3±7.5）mL] and significance was only observed between Group B and Group C (P<0.05). The operating time of both Group A and B were significantly shorter than Group C [（97.5±16.6）min vs.（93.2±13.3）min vs.（103.9±15.0）min，P<0.05]. Conclusion    The incidences of RLN injury of three surgical approaches were similar. The tracheoesophageal groove approach is considered as a better choice for its advantage of less intraoperative blood loss.  

Key words: total thyroidectomy, recurrent laryngeal nerve, recurrent laryngeal nerve injury

摘要：

目的    探讨甲状腺全切除术中3种显露喉返神经方法（入喉点入路、气管食管旁沟入路、甲状腺下动脉入路）的临床疗效。方法    随机选择2014年3月至2015年3月哈尔滨医科大学附属第一医院胰胆外科收治的行双侧甲状腺全切除术病人286例，术前通过细针穿刺明确或超声检查高度怀疑甲状腺恶性疾病、累及双侧腺叶的多发性结节性甲状腺肿、结节性甲状腺肿继发甲状腺功能亢进及Graves病。采用随机数字法将病人分为A组（入喉点入路，97例）、B组（气管食管旁沟入路，96例）、C组（甲状腺下动脉入路，93例）。比较3组病人术后疗效。结果    3组喉返神经损伤发生率［A组 vs. B组vs. C组：1.0% vs. 2.1% vs. 5.4%（下同），P=0.158］及术后住院时间［（2.6±0.5）d vs. （2.5±0.7）d vs. （2.6±0.5）d，F=0.724，P=0.486］差异无统计学意义。在术中出血量方面，A、B组少于C组［（10.1±7.2）mL vs.（12.0±10.0）mL vs.（8.3±7.5）mL］，其中B、C组间差异有统计学意义（P<0.05）；在手术时间方面，A、B组均短于C组，且差异均有统计学意义［（97.5±16.6）min vs.（93.2±13.3）min vs.（103.9±15.0）min，P<0.05］。 结论    入喉点入路、气管食管旁沟入路、甲状腺下动脉入路的喉返神经损伤发生率相近，但气管食管旁沟入路在术中出血量及手术时间上均存在优势，可优先考虑选择。

关键词: 甲状腺全切除术, 喉返神经, 喉返神经损伤