喉返神经端端吻合的疗效与临床应用价值

Clinical evaluation of end-to-end neurorrhaphy for unilateral recurrent laryngeal nerve transaction injury

目的 探索喉返神经直接端端吻合的疗效和临床应用价值.方法 分别采用显微镜、放大镜和肉眼3种条件下对15例甲状腺手术中单侧喉返神经切断伤或因肿瘤侵犯切除者行神经直接端端吻合,26例未行神经修复者作为对照组.根据患者本人和听者的主观感受,从呼吸、发声、自我感受等方面进行疗效评价和比较分析,9例神经吻合者和12例神经未修复者行电子纤维喉镜检查声带运动和喉结构的变化并比较分析.结果 14例喉返神经吻合者在术后2～5个月声音嘶哑恢复至术前正常发音;电子纤维喉镜见喉结构对称,声带张力好,发声时声门闭合好,尽管声带无明显生理运动,但视频下发声时可见杓状软骨轻微内收运动;末行神经修复的26例中仅2例声嘶恢复至接近术前正常发声,声嘶未恢复者患侧杓状软骨固定,不同程度喉萎缩,发声时声门关闭不严.结论 神经直接端端吻合能有效恢复单侧喉返神经切断伤患者的正常呼吸和发音,且操作简便易行.

Objective To investigate the necessity of primary neurorrhaphy （direct end-to-end anastomosis） when the recurrent laryngeal nerve（RLN） is severed during thyroid surgery.Methods 15 patients who suffered from iaotmgenic unilateral complete RLN injury or whose unilateral RLN had to be sacrificed because of disease invasion had a primary repair of RLN by direct end-to-end anastomosis.In control group,26 patients who did not have a nerve repair were enrolled into this study.Subjective evaluation of aspiration and voice quality were based on patient reports and hearer reports for all patients.9 patients with neurorrhaphy and 12 patients without nerve repair were followed with videolaryngoscopic examination.Results 14 patients undergoing neurorrhaphy restored normal voice at 2-5 months postoperatively.Although there were no significant functional motion of the vocal fold,slight adductory movement of the affected arytenoid was found with good tension vocal cords and symmetric arytenoids of the glottis during phonation.Only 2 patients without nerve repair had nearly restored normal voice.The patients with hoarseness had stiff arytenoids and atrophic folds resulting in glottal gap.Conclusions Neurorrhaphy is a simple and effective method to restore the normal aspiration and voice quality of patients with unilateral complete recurrent laryngeal nerve injuries.