甲状腺手术喉返神经损伤的风险因素分析和防治

The risk factors analysis and prevention of recurrent laryngeal nerve injury during thyroid operation

目的探讨甲状腺手术出现喉返神经损伤的风险因素及防治措施。方法回顾性分析2180例甲状腺手术患者的临床资料，按年龄、性别、病变性质、病理类型、麻醉方式、手术次数及术中是否显露喉返神经分组，观察各组患者喉返神经损伤率。结果2180例甲状腺手术患者中有59例（2．7％）发生喉返神经损伤。甲状腺恶性病变、多次手术及不显露喉返神经患者喉返神经损伤率分别为6．7％（33／492）、5．6％（15／267）、4．4％（39/891），显著高于甲状腺良性病变、首次手术及显露喉返神经的1．5％（26／1688）、2．3％（44／1913）、1．6％（20／1289），差异有统计学意义（P〈0．01）。甲状腺背侧病变术中不显露喉返神经患者喉返神经损伤率明显高于甲状腺背侧病变术中显露喉返神经患者[13．7％（29／212）比2．9％（12／417），P〈0．01]。结论甲状腺恶性病变、多次手术可增加甲状腺手术患者喉返神经损伤风险，背侧病变术中常规显露喉返神经可有效减少喉返神经的损伤。

Objective To investigate the risk factors and prevention of recurrent laryngeal nerve injury during thyroid operation. Methods The clinical data of 2180 patients with thyroid operation were retrospectively analyzed. The potential relationship of the incidence rate of recurrent laryngeal nerve injury were evaluated, such as age, gender, nature of lesions, thyroid pathology, anesthesiology, operation times, whether or not to reveal recurrent laryngeal nerve. Results The overall incidence rate of recurrent laryngeal nerve injury postoperatively was 2.7% （59/2180）. The incidence rate of recurrent laryngeal nerve injury in patients with thyroid malignant neoplasms, repeated surgery and without reveal recurrent laryngeal nerve were 6.7% （ 33/492 ）, 5.6% （ 15/267 ） ,4.4% （ 39/891 ）, significantly higher than those in the patients with thyroid benign neoplasms,first time operation and with reveal recurrent laryngeal nerve [1.5% （26/1688）,2.3% （44/1913）, 1.6% （20/1289）] （P 〈 0.01 ）. In the patients with thyroid dorsal lesion, the incidence rate of recurrent laryngeal nerve injury in the patients without reveal recurrent laryngeal nerve was significantly higher than that in the patients with reveal recurrent laryngeal nerve [ 13.7 % （ 29/212 ） vs. 2.9 % （ 12/417 ）, P 〈 0.01 ]. Conclusion Thyroid malignant neoplasms, repeated surgery and without reveal recurrent laryngeal nerve can increase the risk of recurrent laryngeal nerve injury, routine reveal recurrent laryngeal nerve in the patients with thyroid dorsal lesion can decrease the incidence rate of recurrent laryngeal nerve injury.