Analysis of the Influencing Factors of Recurrent Laryngeal Nerve Injury During Thyroid Cancer Lymph Node Dissection and the Applicative Value of Ultrasonic Scalpel

JI Jing; WANG Hanjin; DA Xia; XU Jin; TANG Chongyin; WANG Guozhu

doi:10.13730/j.issn.2097-2148.2023.11.007

Abstract：Objective To analyze the influencing factors of recurrent laryngeal nerve injury in thyroid cancer lymph node dissection and evaluate the applicative value of ultrasonic scalpel.Methods A total of 210 patients diagnosed and treated for thyroid cancer in the author's hospital from January 2020 to December 2021 were selected as the study sub-jects.The patients were divided into observation group and control group,with 105 patients in each,according to the pa-tient's admission number by thier admission sequence number.The patients in the observation group underwent surgical treatment by ultrasonic scalpel,while those in the control group underwent surgical treatment by conventional scalpel.The differences in perioperative indicators and adverse reactions between the two groups were compared.The patients were divided into injury group(n=18)and non-injury group(n=192)according to whether laryngeal nerve injury oc-cured.The influencing factors of recurrent laryngeal nerve injury during lymph node dissection for thyroid cancer were an-alyzed by Logistic regression.Results The operation time,length of surgical incision,24 h drainage volume,total post-operative drainage volume and length of hospitalization in the observation group were significantly lower than those in the control group(all P＜0.05);the incidences of hypoparathyroidism and recurrent laryngeal nerve injury in the observation group was significantly lower than those in the control group(all P＜0.05).The operation principle of the patients with-out recurrent laryngeal nerve injury was more refined capsule dissection,the dissection method from the anatomical trian-gle of recurrent laryngeal nerve was more used,and the surgical scope was more conservative(all P＜0.01).Logistic re-gression analysis showed that non-meticulous capsule dissection,dissection from the inferior horn of the thyroid and ex-tensive surgical scope were risk factors for recurrent laryngeal nerve injury.Conclusion Ultrasonic scalpel has less damage to recurrent laryngeal nerve in thyroid cancer lymph node dissection,the risk factors of recurrent laryngeal nerve injury are the lack of non-meticulous capsule dissection,dissection from the inferior hom of the thyroid and extensive surgical scope.