【摘要】 目的 探讨聚乳酸生物可吸收膜在甲状腺手术中应用的可行性和有效性。方法甲状腺手术患者120例,将120例患者随机分为实验组和对照组。根据术中喉返神经显露程度,又分别分为单侧喉返神经显露组(A组)和双侧喉返神经显露组(B组)两个亚组。实验组患者将聚乳酸生物可吸收膜分别置于甲状腺手术创腔内喉返神经表面和颈前肌群表面与颈阔肌层之间。对照组不使用生物膜。对患者声音状况及颈部不适感进行术后定期随访。结果(1)手术后当天,实验组和对照组患者均未出现声音嘶哑。术后3天后开始有患者出现声音嘶哑,为迟发性声音嘶哑。迟发性声音嘶哑发生率为3.33%(4/120),实验组1例(占1.7%),对照组3例(占5.0%)。采用GRBAS系统评分,实验组和对照组术后各个观察点声音嘶哑发生率比较,差异无统计学意义(P>0.05)。采用TVQ量表评分,实验组和对照组在术后1个月时比较,差异有统计学意义(P<0.05);术后6个月时,仅B组比较,差异有统计学意义(P<0.05);(2)第5天,实验组和对照组电子喉镜随访结果比较差异无统计学意义(P>0.05);术后6个月比较,差异有统计学意义(P<0.05)。(3)术后1个月时,实验组颈部不适感发生比例和严重程度均低于对照组,差异有统计学意义(P<0.05);术后6个月时比较,差异无统计学意义(P>0.05)。结论 聚乳酸生物可吸收膜在甲状腺手术中,具有保护喉返神经,促进声音恢复的作用,可减轻患者术后颈部牵扯及挛缩感。更多还原

【Abstract】 Objective To investigate and study the feasibility and effectiveness of PDLLA(PolyDL-lactic acid) biological absorbable membrane in thyroid surgery.Methods 120 patients were randomly allocated into experimental and control group(60 patients each).According to different level of exposure of the recurrent laryngeal nerves,each group was divided into unilateral RLN subgroup(group A) and bilateral RLN subgroup(group B).In the experimental group,PDLLA biological membrane was placed in the operative region,such as the surface of the recurrent laryngeal nerve and also placed on the superfacial layer of cervical fascia,which was between the platysma and sternohyoid muscle.The PDLLA membrane was not used in the control group.These patients were regularly follow-up after the surgery.The main outcome measures were the voice,dragging sensation and contracture feeling around the neck of the patients after the surgery.Results(1) For the entire experimental and the control groups,no hoarse patients appeared on the operational day.After 3 days,the total delayed on-set hoarse patients are 4(3.33%,4/120),1 hoarse patient in the experimental group(l.7%,1/60) while 3 hoarse patients appeared in the control group(5.0%,3/60).There was no significant difference in statistics of GRBAS between the experimental and control group(P > 0.05),while there was significant difference in statistics of TVQ between the two groups on the first month after surgery(P < 0.05).There was significant difference in statistics by TVQ on the sixth month between group B(P < 0.05).(2) For the experimental and the control groups,there was significant statistical difference in electronic laryngoscope outcomes on the sixth month after surgery(P <0.05) while there is no significant statistical difference on the fifth day(P >0.05).(3)For the patients in the experimental and control groups,both in group A and group B,the dragging sensation and contracture feeling around the neck was significantly different in statistics after Chi-square testson the first month(P < 0.05);there was no significant difference in statistics on the sixth month(P > 0.05).Conclusion The PDLLA medical biological absorbable membrane can protect the recurrent laryngeal nerves and promote and improve the recovery of the voices of the patients who received thyroid surgery.The PDLLA medical biological absorbable membrane can reduce and relieve the painful feeling of the dragging sensation and contracture feeling around the neck in the patients who received thyroid surgery,and improve their postoperative quality of life.更多还原