CAJ | 학술논문

目的：探索喉返神经损伤在甲状腺癌根治手术中的原因及防治措施。方法：分析2008年1月-2013年5月47例行根治性手术治疗的甲状腺癌患者的临床资料,总结引起喉返神经损伤的主要原因、预防措施及损伤后处理方法。结果：47例甲状腺癌患者中,喉返神经损伤5例,其中永久性损伤2例,1例为双侧损伤,暂时性损伤3例,其中1例行气管切开,带管出院,3个月内来院拔出气管导管,恢复功能,定期复查无不适。损伤原因经过回顾性分析,考虑以下几种：此类手术实施过少,解剖层次不清,手术很容易误伤；术野止血不彻底致使视野不清,遇到出血时血泊中盲目钳夹止血误伤；切口过小过度牵拉,特别是拉钩过度过深,使喉返神经被牵拉；出血时缝扎或缝合残余腺体过深；电刀功率过大或距神经较近导致热传导损伤；生物胶止血时直接接触神经导致化学损伤；助手配合失当等。不同术式的损伤发生率也有所不同。结论：甲状腺癌根治切除中喉返神经损伤是常见并发症。熟悉解剖结构、熟练而规范的操作、充分良好的喉返神经的暴露,手术野充分清楚显露、助手很好的配合仍是预防的关键。
목적：탐색후반신경손상재갑상선암근치수술중적원인급방치조시。방법：분석2008년1월-2013년5월47례행근치성수술치료적갑상선암환자적림상자료,총결인기후반신경손상적주요원인、예방조시급손상후처리방법。결과：47례갑상선암환자중,후반신경손상5례,기중영구성손상2례,1례위쌍측손상,잠시성손상3례,기중1례행기관절개,대관출원,3개월내래원발출기관도관,회복공능,정기복사무불괄。손상원인경과회고성분석,고필이하궤충：차류수술실시과소,해부층차불청,수술흔용역오상；술야지혈불철저치사시야불청,우도출혈시혈박중맹목겸협지혈오상；절구과소과도견랍,특별시랍구과도과심,사후반신경피견랍；출혈시봉찰혹봉합잔여선체과심；전도공솔과대혹거신경교근도치열전도손상；생물효지혈시직접접촉신경도치화학손상；조수배합실당등。불동술식적손상발생솔야유소불동。결론：갑상선암근치절제중후반신경손상시상견병발증。숙실해부결구、숙련이규범적조작、충분량호적후반신경적폭로,수술야충분청초현로、조수흔호적배합잉시예방적관건。
To explore the recurrent laryngeal nerve injury in thyroid cancer radical surgery causes and pre-vention measures.Methods:A retrospective analysis from January 2008 to May 2013 47 underwent radical surgery for thyroid cancer patients with clinical data,summarize the main cause of recurrent laryngeal nerve injury,injury preven-tion and treatment methods.Results:47 cases of thyroid cancer patients,recurrent laryngeal nerve injury in five cases, including permanent injury in 2 cases,1 case of bilateral injury,temporary injury in 3 cases,including a routine tracheot-omy,with a pipe and discharged in March to the hospital within the endotracheal tube removed,restore function.Injury After retrospective analysis,consider the following:implementation of such operations is few,anatomical level is un-clear;operative field hemostasis resulting in poor visibility,blind pool of blood hemostasis accidental injury;incision is few to make excessive traction,making throat recurrent nerve is pulled;bleeding suture or suture residual glandular too deep;electrosurgical power is too large or thermal conductivity resulting from nerve damage nearer;biological glue he-mostasis direct contact with nerve cause chemical damage;assistant mismatch and so on.Different surgical injury inci-dence rate is also different.Conclusion:Radical resection of thyroid cancer in the recurrent laryngeal nerve injury re-mains a common complication.Familiar with the anatomy,skilled and standardized operations,adequate exposure of the re-current laryngeal nerve,reveal sufficiently clear surgical field,the assistant is still very good with the key to prevention.