甲状腺再次手术中喉返神经保护研究(附163例分析)

Protection of the recurrent laryngeal nerve in reoperation of thyroid:A analysis of 163 cases

目的探讨甲状腺再次手术中喉返神经的损伤及保护。方法回顾性分析上海交通大学医学院附属瑞金医院2009年1月至2013年12月共收治163例甲状腺术后须再手术病人临床资料,分为A、B和C 3组。A组为甲状腺良性疾病首次行大部或次全切除术后复发再手术者;B组为甲状腺癌首次仅行大部或次全切除术后再手术者;C组为甲状腺乳头状癌首次未行中央区淋巴结清扫术或中央区淋巴结清扫不彻底复发须再手术者。结果3组喉返神经寻找方法略有不同。A、B、C组术后喉返神经暂时性和永久性麻痹发生率分别为8.22%、11.11%、14.81%和2.74%、0、3.70%。结论再次手术寻找喉返神经存在一定困难和风险,故建议一侧腺叶初次手术时,尽量采取腺叶全和(或)近全切除术,摒弃次全和(或)大部切除术。

Objective To investigate the protection of the recurrent laryngeal nerve （RLN） in reoperation of thyroid. Methods The clinical data of 163 cases of reoperation following thyroid surgery admitted between January 2009 and December 2013 in Ru Jin Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. All the cases were divided into 3 groups. Those whose first operative method were subtotal or partial thyroidectomy because of benign disease were divided into Group A; those whose first operative method were subtotal or patial thyroidectomy because of carcinoma were divided into group B ; those whose central lymph node were recurrent after first operation were divided into group C. Results The methods of finding the RLN in reoperation were different among three groups. The incidence of transient RLN palsy was 8.22%, 11.11%, 14.81% in group A, B, C respectively. The incidence of permanent RLN was 2.74%, 0, 3.70% in group A, B, C respectively. Conclusion There are surely some difficulty and risk in reoperation of searching RLN. It suggests that the subtotal or partial tbyroideetomy should be abandoned in hemilobectomy.