Application of fine anatomy combined with exposure of recurrent laryngeal nerve in cricothyroid space in differentiated thyroid cancer surgery / 中国基层医药

ABSTRACT

Objective:To investigate the effect of fine anatomy combined with exposure of recurrent laryngeal nerve in cricothyroid space in differentiated thyroid cancer surgery.Methods:Sixty patients with differentiated thyroid cancer who received treatment in Ningbo Hospital of Traditional Chinese Medicine from January 2017 to April 2020 were included in this study. They were randomly assigned to receive either fine anatomy combined with exposure of recurrent laryngeal nerve in cricothyroid space (observation group, n = 30) or routine surgery + inferior thyroid artery exposure of recurrent laryngeal nerve (control group, n = 30). Operative time, the volume of intraoperative blood loss, and the number of lymph node dissected were compared between the two groups. Parathyroid hormone (PTH) and blood calcium (Ca 2+) concentrations in the two groups were determined. The adverse reactions such as recurrent laryngeal nerve and parathyroid injury were observed in each group. Results:Operative time, the volume of intraoperative blood loss, and the number of lymph node dissected in the observation group were (71.28 ± 10.08) minutes, (16.69 ± 4.65) mL, and (4.78 ± 1.26), respectively, which were significantly different from those in the control group [(69.27 ± 11.89) minutes, (17.14 ± 4.52) mL, (4.76 ± 1.22), t = 0.706, 0.380, 0.062, all P > 0.05]. Before surgery, there were no significant differences in PTH and Ca 2+ concentrations between the two groups [PTH (50.24 ± 11.21) g/L vs. (50.21 ± 11.19) g/L; Ca 2+ (2.18 ± 0.08) mmol/L vs. (2.17 ± 0.09) mmol/L, t = 0.010, 0.454, both P > 0.05]. After surgery, PTH and Ca 2+ concentrations in the observation group were significantly higher than those in the control group [PTH [(31.44 ± 6.09) g/L vs. (16.57 ± 2.35) g/L; Ca 2+ (2.07 ± 0.10) mmol/L vs. (1.23 ± 0.12) mmol/L, t = 12.477, 29.454, both P < 0.01]. Total incidence of adverse reactions in the observation group was significantly lower than that in the control group [10.00% (3/30) vs. 46.67% (14/30), χ2 = 9.931, P < 0.01). Conclusion:Application of fine anatomy combined with exposure of recurrent laryngeal nerve in cricothyroid space in differentiated thyroid cancer surgery is highly effective in the clinic. Accurate identification of recurrent laryngeal nerve in cricothyroid space is helpful to preserve the parathyroid gland and blood supply in situ, leads to a small range of changes in PTH and Ca 2+ concentrations, reduces postoperative complications, so as to protect the recurrent laryngeal nerve and parathyroid gland and thereby promote postoperative recovery.