甲状腺手术时喉返神经损伤的预防和治疗探讨

目的：探讨甲状腺手术时喉返神经损伤的原因,并提出预防和治疗措施。方法：对52例行甲状腺手术时导致喉返神经损伤原因、部位、类型等患者的临床资料进行回顾性分析,依据损伤性质实施相应的治疗措施。采用喉镜、嗓音升学参数、肌电图检查等评价治疗效果。结果：12例行甲状腺术后再次喉返神经探查减压术,8例1-3个月后恢复正常嗓音;3例半年后恢复正常,1例1年后恢复;行喉返神经端端吻合术患者中,13例患者声音显著好转,声带运动正常。对52例患者1年期后声音评估,恢复正常36例（69.2%）,明显改善8例（15.4%）,改善5例（9.6%）,无改善3例（5.8%）。结论：甲状腺手术时喉返神经损伤多与手术时切断、钳夹、缝扎等操作不当有关,加强对喉返神经解剖认知以及提高手术精确操作水平是预防甲状腺手术时喉返神经损伤的关键,在治疗上应参考损伤评估情况进行相应的修复,以建立足够气道,恢复满意声音。

Objective：Study of the reason of laryngeal recurrent nerve injury during thy-roid surgery,and put forwardthe prevention and treatment measures.Method：Collecting 52 cases laryngeal recurrent nerve injury during thyroid surg cry patients,from July in 2008 to April in 2013,collecting These pa-tients＇ damage reason,place,type and other clinical data,and go ahead retrospective analysis,according to the damage properties to imple the corresponding treatment mea-sures.The laryngoscope,voice entrance pa-rameters,electromyography examination evaluation therapeutic effect.Results： 12 cas- es thyroid routine postoperative laryngeal re-current nerve exploration decompression again,8 cases recov-er the normal voice af-ter 1 - 3 months,3 cases recover thenormal voice after 6 months,1 cases recover after one year;In patients with laryngeal recurrent nerve end to end anas-tomosis,13 cases of-patients were significantly improved voice, normal vocal cord movement.52 cases of pa-tients voi-ce assessment after one year, 36 cases recover normal69.2% ）,8 cases obvi-ously improved（15.4% ）,5 cases im-proved（9.6% ）,3 Cases not improve（5.8% ）. Conclusion：Thyroid surgery laryngeal recur-rent nerve injury is associated with misoper-ation,such as surgery more cut seam,clamps, improper operation.Strengthen the laryngeal recurrent nerve anatomy of cognition and improve the level of operation accurate oper-ation isthe key to prevent laryngeal recur-rent nerve injury during thyroid surgery. Should refer to the damage assessment on the treatment of the corresponding to repair, to build up enough airway and recover satis-factory voice.