甲状腺切除病例喉返神经损伤的分析

Thyroidectomy and injury of recurrent laryngeal nerve

目的 :研究甲状腺切除术的主要并发症——喉返神经 ( RL N)麻痹的相关因素。方法 :回顾性研究 15 6 3例甲状腺手术患者的临床资料 ,重点分析 RL N损伤与术式、RL N在术中是否被分离保护以及与甲状腺疾病的病理关系。结果 :RL N损伤率是 7.8% ,与组织病理恶性程度明显相关 ( P<0 .0 1) ;但术中如明确找到 RL N并加以保护 ,术后则无 RL N永久性损害 ,暂时麻痹仅为 1.6 %。结论 :术中对 RL N的保护应该强调避免医源性损伤和继发性损害 。

Objective:To study factors related to recurrent laryngeal nerve (RLN) paralysis,a major complication of thyroidectomy.Method:Retrospective study of outcome of patient's medical records in Xijing Hospital and Tumor Hospital of Liaoning Province.Records of 1 563 patients who underwent thyroidectomy by departments of general surgery,ENT and head&neck surgery at these two hospitals were reviewed for RLN paralysis. Main outcome measures:RLN injury was analyzed in relation to types of surgery,RLN identification,and histopathology.Result:The incidence of RLN paralysis was 7.8 %,and significantly related to the histopathologic findings of malignancy (P<0.01). The positive identification and prevention of RLN would not be in either permanent RLN paralysis or temporary RLN paralysis, and the types of surgery were not found to be significant factors in both paralysis.Conclusion:RLNs should be identified to avoid iatrogenic injury and subsequent paralysis,and meticulous surgical technique should be applied in patients whose results of biopsy suggested malignancy.