Recurrent Laryngeal Nerve Tunnel Dissection Combined With The En-bloc Technique In Radical Thyroid Cancer Surgery

Objective:To investigate the safety,feasibility and effectiveness of recurrent laryngeal nerve tunnel anatomy combined with En-bloc technique in radical operation of thyroid cancer.Methods:The clinical data of 195 patients with thyroid cancer admitted to Shaoxing Central Hospital from September 2020 to September 2022 were retrospectively analyzed.Subjects were divided into 2 groups according to different surgical methods.Control group:adenolobectomy was performed by conventional vascular cluster ligation combined with inferior thyroid artery exposure of recurrent laryngeal nerve+central group lymph node dissection;In the experimental group,adenolobectomy was performed using recurrent laryngeal nerve tunnel anatomy combined with En-bloc technique.Clinical data including general data,intraoperative blood loss and other operation-related indicators,number of central lymph node dissection and metastasis,serum PTH and serum Ca²⁺levels before and after surgery,parathyroid transplantation rate and misoperation rate,postoperative complications,and total recurrence and metastasis rate were collected and analyzed by statistical software.Results:All 195 patients successfully completed the operation.There were significant differences in intraoperative blood loss,number of central lymph nodes dissection,incidence of complications（parathyroid and recurrent laryngeal nerve injury）and parathyroid transplantation between the two groups（P<0.05）.The serum PTH level in the experimental group was lower than that before surgery but higher than that in the control group at 3 days and 1 month after surgery（P<0.05）.The serum Ca²⁺level in the experimental group was lower than that before surgery but higher than that in the control group（P<0.05）.There were no significant differences in general data,other surgery related indexes and total recurrence and metastasis rate（P>0.05）.Conclusion:The use of recurrent laryngeal nerve tunnel anatomy combined with En-bloc technique is safe and feasible in radical thyroid cancer surgery,reducing intraoperative bleeding and increasing the number of lymph nodes dissected,to effectively protect the laryngeal nerve and parathyroid glands and reduce the incidence of complications.