甲状腺手术致双侧喉返神经麻痹的喉返神经减压治疗

Recurrent laryngeal nerve decompression for bilateral recurrent laryngeal nerve paralyses after thyroid surgery

目的 探讨对早期甲状腺手术所致的双侧喉返神经麻痹行喉返神经减压治疗的可行性及疗效.方法 2005年3月至2013年6月对15例病程在3个月以内的甲状腺手术所致的双侧喉返神经麻痹的患者行喉返神经探查术.15例患者中8例为既往两次手术先后致两侧喉返神经麻痹,7例为一次手术致双侧喉返神经麻痹.结果 15例患者共探查22侧损伤的喉返神经,其中9侧神经被切断,10例患者的13侧神经被结扎及缝扎,对被结扎和缝扎的喉返神经行减压治疗.电子喉镜观察手术前、术后声带活动度的变化,评价手术效果.8例经两次甲状腺手术的患者中的5例神经被结扎行减压术者均于术后1～4个月内拔管,除1例患者声带外展稍差外,其余4例声带活动恢复正常.单次手术致双侧喉返神经损伤的7例患者中,5例行神经减压术者（2例单侧减压,3例双侧减压）均于术后1～6个月实现拔管.其中1例单侧声带外展略受限,1例双侧声带活动度略差.结论 对因甲状腺手术所致的双侧喉返神经麻痹,应尽早行喉返神经探查及减压术,可使其恢复成为单侧喉返神经麻痹或完全正常的状态,从而有效改善呼吸,拔除气管套管.

Objective To study the feasibility and therapeutic effect of recurrent laryngeal nerve （RLN） decompression in the treatment of bilateral paralyzed RLN after thyroid surgery.Methods From March 2005 to June 2013,15 cases of bilateral RLN paralyses occurring within 3 months after thyroid surgery were treated with RLN decompression.Bilateral RLN paralyses were caused by revised thyroid surgery in 8 cases and by primary thyroid surgery in 7 cases.Results RLN injuries were found in 15 cases/ 22 side,including RLN-cut in 9 sides and RLN-ligated in 13 sides.RLN decompression was performed in the 10 cases/13 sides of ligated RLN.Vocal cord mobility was detected through electrolaryngoscope for evaluating the postoperative functional recovery of decompressed RLN.Of 8 patients with bilateral RLN paralyses due to the ligation of RLN after previous revised thyroid surgeries,functional adduction and abduction of the vocal cord was recovered completely in 4 patients and recovered basically with a slight weak abduction in one patient after RLN decompression,and the 5 patients were decannulated in 1-4 months postoperatively.For 7 patients with bilateral RLN paralyses resulted from previous primary surgeries,unilateral or bilateral RLN decompress was performed in 2 cases and in 3 cases respectively.The mobility of the paralyzed vocal cord restored in 1-6 months after RLN decompression,besides one case with relative deficient abduction and one case with slight limited abduction and adduction,and the 5 patients were decannulated successfully.Conclusion Exploration surgery could be performed as soon as possible in patients with bilateral RLN paralyses and RLN decompress is effective for the restoration of the function of the nerve.