甲状腺术后迟发性声音嘶哑临床分析

Clinical analysis of delayed-onset hoarseness after thyroidecomy

目的探讨甲状腺手术后迟发性声音嘶哑的发生原因及治疗措施。方法对近10年间收治的3180例甲状腺手术患者及术后发生迟发性声音嘶哑102例(3.2%)的临床资料进行回顾性分析。结果甲状腺癌术后迟发性声音嘶哑发生率为5.1%(20/398),明显高于良性病变的2.9%(82/2791)(P<0.05);不保留后被膜,于包膜外甲状腺下动脉主干结扎发生迟发性声音嘶哑43例(4.8%),明显高于保留后被膜,在包膜内结扎甲状腺下动脉分支者(2.3%)(P<0.05);再次手术者的发生率(6.5%)明显高于初次手术者(3.0%)(P<0.05)。显露和不显露喉返神经,迟发性声音嘶哑发生率分别为3.1%和3.3%,两者无明显差异(P>0.05)。超声检查发现声音嘶哑的患者均有不同程度的手术创腔内积液。77例发病后给予综合治疗,治愈75例(97.4%),恢复率明显高于未治疗者(84.0%)(P<0.05)。结论手术中减少组织损伤,减轻组织炎症水肿及术后创腔充分引流,可预防甲状腺手术后迟发性声音嘶哑发生。采取积极有效的综合治疗是治愈这一并发症的关键。[中国普通外科杂志,2007,16(1):12-14]目的探讨甲状腺手术后迟发性声音嘶哑的发生原因及治疗措施。方法对近10年间收治的3180例甲状腺手术患者及术后发生迟发性声音嘶哑102例(3.2%)的临床资料进行回顾性分析。结果甲状腺癌术后迟发性声音嘶哑发生率为5.1%(20/398),明显高于良性病变的2.9%(82/2791)(P<0.05);不保留后被膜,于包膜外甲状腺下动脉主干结扎发生迟发性声音嘶哑43例(4.8%),明显高于保留后被膜,在包膜内结扎甲状腺下动脉分支者(2.3%)(P<0.05);再次手术者的发生率(6.5%)明显高于初次手术者(3.0%)(P<0.05)。显露和不显露喉返神经,迟发性声音嘶哑发生率分别为3.1%和3.3%,两者无明显差异(P>0.05)。超声检查发现声音嘶哑的患者均有不同程度的手术创腔内积液。77例发病后给予综合治疗,治愈75例(97.4%),恢复率明显高于未治疗者(84.0%)(P<0.05)。结论手术中减少组织损伤,减轻组织炎症水肿及术后创腔充分引流,可预防甲状腺手术后迟发性声音嘶哑发生。采取积极有效的综合治疗是治愈这一并发症的关键。

Objective To investigate the cause and treatment of delayed-onsef hoarseness after thyroideeomy. Methods The clinical data of 3180 cases of thyroid disease treated by surgery in our department between 1995- 2005 and the 102 cases （3. 2% ） who developed postoperative delayed-onset hoarseness were analyzed respectively. Results The complication rate of postoperative delayed-onset hoarseness for thyroid carcinoma was 5. 1% , which was obviously higher than that of benign thyroid disease （ 2.9 % ） （ P 〈 0.05）. The rate in patients in whom the inferior thyroid arteries were ligated intracapsularly and the posterior thyroid capsule was retained （2.3 % ） was significantly lower than that in patients with extraeapsular ligation of the arteries and the posterior capsule was not retained （4. 8%, P 〈 0. 05 ）. The complication rate in reoperative patients （6. 5 % ） was markedly higher than that in patients who underwent primary operation （3.0 % ） （P 〈 0.05 ）. However, there was no differenee between the cases in which the recurrent laryngeal nerves were exposed and those in which the nevers were not exposed（ P 〉0.05 ）. In all of the patients with delayed-onset hoarseness, ultrasonographic examination showed various degrees of fluid accumulation in the operative field. Seventy-five of 77 cases（ 97.4% ） with this complication were cured with eombined theropy, which was significantly higher than the recovery rate of those cases without treatment （84. 0 % ） （P 〈0.05）. Conclusions Adequate drainage plays an important role in preventing delayed-onset hoarseness. Applying aggressive combined therapy is the key point to cure this complication.