甲状腺手术中防治喉返神经损伤的探讨

Study on Injury of Recurrent Laryngeal Nerve in Thyroidectomy

目的探讨甲状腺手术中防治喉返神经损伤的方法。方法回顾性分析我院260例甲状腺手术病例中喉返神经损伤的情况。结果喉返神经损伤4例(1.6%),横断伤2例,钳夹1例,癌侵犯1例。2例横断伤,术中行端端吻合,1例癌侵犯喉返神经者,当即予以自体耳大神经移植修复神经损伤。4例随访1年,声音恢复满意。结论甲状腺手术中喉返神经损伤多为机械性损伤,对于甲状腺全切除术、体积较大的甲状腺次全切除术应该常规显露喉返神经。喉返神经损伤一经诊断尽早手术修复。

Objective to investigate the prevention and treatment of recurrent laryngeal nerve （RLN） injury induced by thyroid operation. Methods Clinical data of 260 patiems with RLN injury caused by thyroid operation in my hospital was analyzed retrospectively. Results RLN injury occurred in 4 cases （1.6%）, Transection of the nerve was found in 2 cases, blind gapping 1 case, carcinoma invading 1 case. Damaged RLN of 2 cases of transection was performed end to end anastomosis .1 case of carcinoma invading repaired by grafting great attficular nerve immediately, 4 cases were followed up for 1 year, phonation restored satisfied. Conclusions Most RLN injuries caused by thyroid operation are mechanical. RLN Should be exposed actively in total thyroidectomy or subtotal thyroidectomy with large thyroid. Once RLN injury is found ,reinnerration should be performed as soon as possible.