自体颈丛神经移植修复喉返神经缺损18例报告

Cervical plexus reinnervation for recurrent laryngeal nerve injuries

目的探讨采用自体颈丛神经移植一期或延迟一期修复喉返神经缺损的手术方法及其疗效。方法18例声音嘶哑的甲状腺癌患者（包括6例肿瘤侵犯喉返神经患者，3例瘢痕包裹及线结缝扎喉返神经的患者及9例喉返神经离断患者）在行甲状腺癌根治性切除手术后，选用术中保留的颈丛神经深支或浅支移植修复喉返神经。治疗前后以喉镜、嗓音主观评估等评价手术效果。结果全部患者均得到3个月至2年的随访（平均8个月），其中16例患者声带不同程度的恢复了外展运动，2例声带未恢复运动，声带外展运动恢复率为88．9％（16／18）。结论自体颈丛神经移植一期或延迟一期修复喉返神经缺损术式简便易行，能有效地恢复声带外展运动，成功率高。

Objective To explore the clinical therapeutic effects of Ⅰ -stage or delayed Ⅰ -stage cervical plexus reinnervation for recurrent laryngeal nerve（ RLN ） injuries. Methods During the process of neck dissection of papillary thyroid carcinoma, 18 cases with recurrent laryngeal nerve deficit underwent cervical plexus reinnervation on Ⅰ -stage or delayed Ⅰ-stage RLN prosthesis basis. Therapeutic effects were evaluated by fibrolaryngoscope and voice evaluation preoperatively and postoperatively. Results All the cases were followed-up for 3 months to 2 years （ average 8 months）. Abductory motion of the vocal cords of 16 patients totally or partly restored, and not improved in 2 patients, with the recovery rate of abductory motion of the paralyzed vocal cords of 88.9% （16/18）. Patient＇s phonation was restored totally or partially in 16 cases and the hoarseness was ameliorated significantly. Conclusions Cervical plexus-RLN reinnervation should be considered as a suitable treatment for unilateral vocal cord paralysis. One stage or delayed one stage cervical plexus reinnervation for recurrent laryngeal nerve injury is convenient and easy to perform. Postoperatively the abductory motion of vocal cord could be restored by this reinnervation satisfactorily.