自体静脉移植桥接修复喉返神经缺损的疗效

Autologous vein graft as a conduit for repairing the recurrent laryngeal nerve deficit

目的评价自体静脉移植桥接修复喉返神经缺损的效果。方法回顾性分析 17例喉返神经横断性损伤采用自体静脉移植桥接修复的临床资料。 17例均为甲状腺手术损伤所致。损伤部位 :右侧 5例 ,左侧 12例。结果损伤后至修复时间为术中发现后立即修复至术后 10个月。术中见损伤发生在喉返神经入喉处下方 2cm以内者 16例 ( 94 1% ) ,甲状腺下动脉平面 1例 ( 5 9% )。神经缺损长度 0 5～ 4cm。 17例中 16 ( 94 1% )例获 1 5年以上随访 ,声音恢复正常的 12例 ( 75 0 % ) ,明显好转的 3例 ( 18 8% ) ,好转 1例 ( 6 2 % )。 15例获喉镜检查 ,其中声带恢复正常活动的 4例( 2 6 7% ) ,恢复部分活动的 3例 ( 2 0 0 % ) ,未恢复活动的 8例 ( 5 3 3% )。

Objective To evaluate the result of autologous vein graft used as a conduit for repairing the iatrogenic recurrent laryngeal nerve(RLN) deficit.Methods Iatrogenic RLN deficit was repaired by using antogeneous vein graft as a conduit in 17 patients. RLN deficit occurred in right side in 5 cases, in left side in 12. Results The RLN injuries were located within 2 cm below the point of RLN entering throat in 16 cases(94 1%), near the inferior thyroid artery in 1(5 9%). The length of RLN deficit was between 0 5～4 cm. Among the 17 cases, 16(94 1%) were followed up for more than 1 5 years. Of them, normal phonation was achieved in 12 cases(75 0%), significantly improved in 3(18 8%) and slightly improved in 1(6 2%).Among the 15 cases who received indirect or direct laryngoscopy, the affected vocal cord movement entirely recovered in 4 cases(26 7%), partially recovered in 3(20 0%), unchanged in 8(53 3%) Conclusions Autogeneous vein graft is ideal for repairing RLN deficit.