甲状腺手术中喉返神经损伤原因及预防

Reasons and preventions for damage of recurrent laryngeal nerve in thyroid surgery

目的探讨甲状腺手术中喉返神经损伤的医源性原因和防治措施。方法回顾性分析华中科技大学同济医学院附属协和医院2003年6月至2006年8月间手术治疗甲状腺疾病1174例的临床资料,分析喉返神经损伤41例和再次手术与喉返神经在术中是否被分离显露的关系。结果初次手术、再次手术和2次以上手术暂时性喉返神经损伤率分别为2.1%、3.8%、9.5%,永久性喉返神经损伤率为1.0%、1.5%、4.8%。手术中解剖喉返神经和未解剖喉返神经的暂时性喉返神经损伤率为2.3%、2.5%;永久性喉返神经损伤率为0.2%、2.3%。结论甲状腺癌和甲状腺再次手术容易造成喉返神经损伤。术中常规解剖喉返神经可减少永久性喉返神经损伤。术中喉返神经完整解剖者,术后声嘶多为暂时性,保守治疗可恢复。对原因不明的喉返神经麻痹,应早期手术探查,尽量恢复神经功能。

Objective To investigate the reasons and the preventive measures of recurrent laryngeal nerve （ RLN ） injury during operations in patients with thyroid neoplasm. Methods The clinic data of 1 174 eases of thyroid neoplasm in a single unit （department of breast and thyroid surgery center, Union hospital,Tongji medical college, Huazhong university of science and technology） from June 2003 to August 2006 were surveyed retrospectively, The relationships of 41 eases postoperative RLN injury between type of operation, routine identification and unidentifieation of the RLN during the operation were analyzed. Results Transient RLN injury in primary, second time and over two times operation were 2. 1% , 3.8%and 9. 5% respectively. Permanent RLN injury in primary,second time and over two times operation were 1.0% , 1.5% and 4. 8% respectively. Routine identification and no identification RLN inducing transient RLN injury were 2. 3% and 2.5% respectively,whereas permanent RLN injury were 0. 2% and 2. 3% respectively, Conclusion Operations for thyroid cancer and reoperation for thyroid diseases demonstrate higher RLN injury rates siguifieantly. Routine nerve exposure remain crucial to the minimization of permanent RLN injury. And the way always cause temporary RLN injury immediately postoperation which can complete recovery with expectant treatment as long as RLN was anatomically intact. Once RLN inju- ry without certain cause was made ,an operation should be performed as early as possible to recovering the function of RLN.