甲状腺叶切除术后咽喉部充血水肿的原因探讨及预防

Exploration of the causes and preventive measure of congestion and edema in pars laryngea pharynges of patients with thyroid neoplasm after thyroidectomy

目的探讨甲状腺肿瘤行喉返神经解剖+腺叶切除术后咽喉部疼痛充血水肿(并发症)的原因及预防措施。方法回顾性分析159例甲状腺肿瘤行喉返神经解剖+腺叶切除术的手术资料及术后出现咽喉部疼痛充血水肿等症状体征及辅助检查资料,包括手术时间与症状等,对产生并发症的原因进行分析。结果159例发生轻度-重度咽喉部疼痛107例(67.30%),检查患侧单部位血水肿(会厌、会厌谷、披裂、室带、声带)37例,2处43例,3处11例,多部位16例,以披裂单发多见,时间为术后1～7d。处理方法:术后常规抗生素抗炎,局部雾化吸入,严重病例肌内注射或静脉点滴地塞米松5～10mg,并做好气管切开准备。出院后随访3个月恢复。呼吸困难者即刻行气管切开术,打开伤口,清理血肿,抗炎对症,症状体征消失后7d堵管48h后拔管愈合。结论该手术术式保护了喉返神经,降低了喉返神经损伤发生率,但影响了喉的血管淋巴循环,可能损伤了喉上神经。手术要操作轻柔,解剖层次更清晰,更应保护除肿瘤以外的正常组织。

Objective To investigate the causes and preventive measure for pain, congestion and edema in pars laryngea pharynges of patients with thyroid neoplasm after recurrent laryngeal nerve （RLN） anatomy and thyroidectomy. Methods The clinical data of 159 patients thyroid neoplasm who underwent RLN anatomy and thyroidectomy,with postoperative complications and auxiliary examinations including pain, congestion and edema in pars laryngea pharynges, operation time, symptoms and signs, were retrospectively analyzed in order to explore the causes of complications. Results Among 159 patients, there were 107 patients （67.29%） had pharyngeal pain, bung and breath holding with congestion and edema of laryngopharyngeal mucous confirmed by indirect laryngoscope or strobolaryngoscope. The epiglottis, epiglottic vallecula, epiglottic fold, ventricular bands of broken side and the epiglottic fold of opposite side were affected. One patient had hoarseness, one patient had breath holding and dyspnea. Conclusion This operation method can protect the recurrent laryngeal nerve and reduce the incidence of recurrent laryngeal nerve damage, but affect the blood vessel and lymph circulation, and may even injure superior laryngeal nerve. So we should operate softly, make anatomical layer more clearly and protect the normal pars outside the tumor tissue.