外科手术治疗甲状腺手术所致喉返神经损伤

Surgical treatment of recurrent laryngeal nerve injury caused by thyroid operation

目的探讨外科手术治疗喉返神经(RLN)损伤的疗效。方法回顾性分析38年来外科手术治疗的57例甲状腺手术所致RLN损伤的原因、部位、类型及其疗效。结果57例中共损伤RLN 61支(其中双侧神经损伤4例)。右侧RLN损伤27支,左侧34支。造成RLN损伤的手术:甲状腺叶全切除26例次(42.6%),甲状腺叶次全切除术30例次(49.2%),腺瘤或囊肿摘除术5例次(8.2%)。损伤部位位于RLN入喉处下方2cm以内者49支(80.3%),其他部位12支(19.7%)。RLN横断性损伤者23支(37.7%),缝扎或瘢痕压迫者38支(62.3%)。术后51例(89.5%)获1年以上随访,发音恢复正常或明显好转者49例,占96.1%;声音好转者2例,占3.9%。42例46支神经接受间(直)接镜喉镜检查,其中声带活动恢复正常的26侧(支)(56.5%),部分恢复活动的8侧(支)(17.4%),未恢复活动的12侧(支)(26.1%)。4例双侧RLN损伤者均于出院前拔除气管导管。全组患者发音及声带活动的恢复与修复手术时间及手术方式均无明显关系。结论绝大部分甲状腺手术所致RLN损伤发生在其入喉处附近,外科手术是RLN损伤确切有效的治疗方法。

Objective To investigate the therapeutic effect of operation for the recurrent larygeal nerve （ RLN ） injury caused by thyroid operation. Methods Fifty-seven cases of RLN injury caused by thyroid operation during past 38 years and its causes, location, types and curative effect were retrospectively analyzed. Results Amony the 57 cases, 4 had bilateral RLN injury, thus injury occurred in a total of 61 RLNs. Twenty-Seven RLN injuries occurred on the right side and 34 on the left side. The operation which resulted in RLN injury included 26 thyroid lobectomies （ 42.6 % ） , 30 subtotal thyroidectomies （ 49.2 % ） and 5 thyroid adenoma or cyst enucleation （ 8.2 % ） . The RLN injuries were located within 2 cm below the point of RLN entering to throat in 49 nerves （80.3%）, and at other places in 12 nerves（19.7%）. Transection of the nerve was found in 23 nerves （ 37.7 % ） , and suture or scar pressure of the nerve in 37 nerves （ 62.3 % ） . After operative treatment of the RLN injury, 51 cases （ 89.5 % ） were followed up for more than 1 year. Among the 51 followed - up patients, phonation was restored to normal or obvious improvement in 49 cases （96.1%）, and improvement in 2 （3.9%）. Of the 42 patients with 46 RLN injury who underwent indirect or direct laryngoscopy, the affected vocal cord movement completely recovered in 26 vocal cords （56.5 % ） , partially recovered in 8 vocal cords（ 17.4 % ） , and no recovery was found in 12 vocal cords （26. 1% ）. In all the 4 patients who underwent tracheotomy, the tubes were withdrawn before discharge. There was no relation between the recovery of phonation or vocal cord movement with the timing or the mode of reparative operation. Conclusions The location of most RLN injuries caused by thyroid surgery is just below the point of RLN entrance into the throat. Surgical operation is a sure and effective way to deal with RLN injury caused by thyroid operation.