Analysis Of The Related Risk Factors Of Recurrent Laryngeal Nerve And Parathyroid Injury In Endoscopic Thyroid Surgery

Objective Retrospective analysis of clinical and pathological data of 480patients underwent endoscopic thyroid surgery in Department of General Surgery of The Second Affiliated Hospital of Guangxi Medical University.Analysis of the related risk factors of recurrent laryngeal nerve and parathyroid injury in endoscopic thyroid surgery.To provide theoretical basis and clinical data for the prevention and treatment of recurrent laryngeal nerve and parathyroid injury in endoscopic thyroid surgery.Methods Clinical data of 480 patients underwent endoscopic thyroid surgery in our hospital between January 2018 and December 2020 were analyzed retrospectively.The age,sex,location of tumor,thyroid pathology,the number of surgery times,surgical approaches,blood loss,operative time,the extent of surgery,surgical options,exposure of the recurrent laryngeal nerve and central neck dissection were included as independent variable.And recurrent laryngeal nerve and parathyroid injury were included as dependent variable.Univariate analysis and multivariate Logistic regression analysis were used to calculate the related risk factors of recurrent laryngeal nerve and parathyroid injury in endoscopic thyroid surgery.Results In 480 patients,17 cases had recurrent laryngeal nerve injury in endoscopic thyroid surgery and the total injury rate was 3.54%,and all were the temporary injury.27 cases had parathyroid injury in endoscopic thyroid surgery and the total injury rate was 5.63%.The temporary injury were 22cases(4.59%)and the eternal injury were 5 cases(1.04%).Single factor analysis showed that the incidence of recurrent laryngeal nerve injury were significantly higher in the patients with thyroid carcinoma,repeated surgery,extensive operation and non-exposure of recurrent laryngeal nerve(x~2=14.385、9.628、4.117、5.191,P<0.05).Single factor analysis showed that the incidence of parathyroid injury were significantly higher in the patients with thyroid carcinoma,repeated surgery,bilateral lobectomy and central neck dissection(x~2=10.919、11.417、10.532、4.135,P<0.05).In endoscopic thyroid carcinoma surgery and extensive operation,exposure of the RLN can help to reduce the incidence of recurrent laryngeal nerve injury(x~2=11.646、8.541,P<0.05).In endoscopic thyroid benign tumor surgery and conservative surgery,the rates of RLN injury were not significantly different in patients with and without exposure of the RLN(x~2=0.434、0.004,P>0.05).According to multivariate Logistic regression analysis,thyroid carcinoma(OR=4.825,95%CI=1.337～17.406)、repeated surgery(OR=4.600,95%CI=1.039～20.366)and extensive operation(OR=4.412,95%CI=1.216～16.007)were the independent risk factors of recurrent laryngeal nerve injury.And thyroid carcinoma(OR=3.730,95%CI=1.059～13.137),bilateral lobectomy(OR=3.581,95%CI=1.115～11.496)and central neck dissection(OR=5.263,95%CI=1.376～20.125)were the independent risk factors of parathyroid injury(all P<0.05).Conclusion The recurrent laryngeal nerve injury in endoscopic thyroid surgery is related to thyroid carcinoma,repeated surgery and extensive operation.Reduced operative range and individual exposure of the RLN can help to reduce the incidence of recurrent laryngeal nerve injury in thyroid carcinoma surgery.Particularly,it is supposed to avoid damage to recurrent laryngeal nerve in repeated surgery.Bilateral lobectomy and central neck dissection increase the risk of parathyroid injury in endoscopic thyroid carcinoma surgery,but identify and protect parathyroid glands can decrease the incidence of parathyroid injury.