中华肿瘤杂志
中華腫瘤雜誌
중화종류잡지
CHINESE JOURNAL OF ONCOLOGY
2014年
8期
621-625
,共5页
冯云%杨大章%刘丹丹%陈剑%毕青铃%罗克强
馮雲%楊大章%劉丹丹%陳劍%畢青鈴%囉剋彊
풍운%양대장%류단단%진검%필청령%라극강
甲状腺肿瘤%外科手术%喉返神经%治疗结果
甲狀腺腫瘤%外科手術%喉返神經%治療結果
갑상선종류%외과수술%후반신경%치료결과
Thyroid neoplasm%Surgical procedures,operative%Recurrent laryngeal nerve%Treatment outcome
目的 探讨即时喉返神经修复术在治疗甲状腺癌侵及喉返神经中的应用.方法 对10例甲状腺癌侵及单侧喉返神经的患者行甲状腺癌根治术的同时行喉返神经修复术,手术方法为喉返神经松解术、喉返神经直接吻合术、颈袢神经喉返神经吻合术和神经肌蒂移植术.其中行喉返神经松解术1例,喉返神经直接吻合术1例,颈袢神经喉返神经吻合术7例,颈袢神经喉返神经吻合术合并对侧颈袢神经肌肉蒂环杓侧肌移植术1例.以喉镜、最大发音时间(MPT)、发音效能指数(PEI)、嗓音评估来评价手术效果.结果 10例甲状腺癌侵及单侧喉返神经患者术后无肿瘤复发,无甲状旁腺功能低下等并发症.10例患者术后声音嘶哑症状改善,患者嗓音恢复正常或近似正常.喉镜检查显示,术后声门闭合良好,患者声带恢复了正常的肌张力及体积,声带振动及黏膜波对称.手术前后的MPT分别为(4.52 ±0.89)s和(11.91±1.87)s,差异有统计学意义(P＜0.01);手术前后的PEI分别为(1.37±0.43) s/L和(4.02±1.33) s/L,差异有统计学意义(P＜0.05).结论 对甲状腺癌侵及单侧喉返神经患者,在根治甲状腺癌的同时施行喉返神经修复术,能有效恢复患者的发音功能,提高患者的生活质量.
目的 探討即時喉返神經脩複術在治療甲狀腺癌侵及喉返神經中的應用.方法 對10例甲狀腺癌侵及單側喉返神經的患者行甲狀腺癌根治術的同時行喉返神經脩複術,手術方法為喉返神經鬆解術、喉返神經直接吻閤術、頸袢神經喉返神經吻閤術和神經肌蒂移植術.其中行喉返神經鬆解術1例,喉返神經直接吻閤術1例,頸袢神經喉返神經吻閤術7例,頸袢神經喉返神經吻閤術閤併對側頸袢神經肌肉蒂環杓側肌移植術1例.以喉鏡、最大髮音時間(MPT)、髮音效能指數(PEI)、嗓音評估來評價手術效果.結果 10例甲狀腺癌侵及單側喉返神經患者術後無腫瘤複髮,無甲狀徬腺功能低下等併髮癥.10例患者術後聲音嘶啞癥狀改善,患者嗓音恢複正常或近似正常.喉鏡檢查顯示,術後聲門閉閤良好,患者聲帶恢複瞭正常的肌張力及體積,聲帶振動及黏膜波對稱.手術前後的MPT分彆為(4.52 ±0.89)s和(11.91±1.87)s,差異有統計學意義(P＜0.01);手術前後的PEI分彆為(1.37±0.43) s/L和(4.02±1.33) s/L,差異有統計學意義(P＜0.05).結論 對甲狀腺癌侵及單側喉返神經患者,在根治甲狀腺癌的同時施行喉返神經脩複術,能有效恢複患者的髮音功能,提高患者的生活質量.
목적 탐토즉시후반신경수복술재치료갑상선암침급후반신경중적응용.방법 대10례갑상선암침급단측후반신경적환자행갑상선암근치술적동시행후반신경수복술,수술방법위후반신경송해술、후반신경직접문합술、경번신경후반신경문합술화신경기체이식술.기중행후반신경송해술1례,후반신경직접문합술1례,경번신경후반신경문합술7례,경번신경후반신경문합술합병대측경번신경기육체배표측기이식술1례.이후경、최대발음시간(MPT)、발음효능지수(PEI)、상음평고래평개수술효과.결과 10례갑상선암침급단측후반신경환자술후무종류복발,무갑상방선공능저하등병발증.10례환자술후성음시아증상개선,환자상음회복정상혹근사정상.후경검사현시,술후성문폐합량호,환자성대회복료정상적기장력급체적,성대진동급점막파대칭.수술전후적MPT분별위(4.52 ±0.89)s화(11.91±1.87)s,차이유통계학의의(P＜0.01);수술전후적PEI분별위(1.37±0.43) s/L화(4.02±1.33) s/L,차이유통계학의의(P＜0.05).결론 대갑상선암침급단측후반신경환자,재근치갑상선암적동시시행후반신경수복술,능유효회복환자적발음공능,제고환자적생활질량.
Objective To explore the application of immediate recurrent laryngeal nerve reconstruction in the treatment of thyroid cancer invading the recurrent laryngeal nerve.Methods Ten patients with thyroid cancer invading unilateral recurrent laryngeal nerve underwent radical surgery and immediate recurrent laryngeal nerve reconstruction.The reconstructive surgical approach included recurrent laryngeal nerve decompression surgery,end-to-end anastomosis of the recurrent laryngeal nerve,anastomosis of ansa cervicalis nerve to the recurrent laryngeal ncrve,and nerve-muscle pedicle (NMP) technique.Among the ten patients,one underwent nerve decompression,one underwent end-to-end anastomosis of the recurrent laryngeal nerve,seven had anastomosis of ansa cervicalis to recurrent laryngeal nerve,and one case had anastomosis of ansa cervicalis to recurrent laryngeal nerve combined with nerve-muscle pedicle (NMP) technique.The effect of surgery was evaluated by videolaryngoscopy,maximum phonation time (MPT),phonation efficiency index (PEI) and voice assessment.T-test was used in the statistical analysis.Results All of the 10 patients had no complications including tumor recurrence and hypoparathyroidism after the surgery.Their hoarseness symptoms were improved,and the patients returned to normal or nearnormal voice.Postoperative videolaryngoscopy showed that paralyzed vocal cord returned to normal muscle tone and volume,and the vocal cord vibration and mucosal wave were symmetric and the patients got good glottal closure.The pre-and post-operative maximum phone times of the patients were (4.52 ± 0.89) s and (11.91 ± 1.87) s,respectively (P ＜0.01).The pre-and post-operative phonation efficiency indices were (1.37±0.43) s/Land (4.02±1.33) s/L,respectively (P＜0.05).Conclusions In patients with thyroid cancer invading unilateral recurrent laryngeal nerve,immediate recurrent laryngeal nerve reconstruction following radical surgery of thyroid cancer can effectively achieve recovery in phonation function and improve the quality of life of the patients.
