甲状腺全切除术中喉返神经损伤原因分析

Recurrent laryngeal nerve injury during total thyroidectomy

目的探讨甲状腺全切除术中喉返神经损伤机制。方法回顾性分析2003至2014年36例甲状腺全切除术中喉返神经损伤患者的临床资料。结果36例患者中暂时性喉返神经损伤21例，永久性喉返神经损伤15例。损伤原因包括巨大甲状腺、喉返神经变异、二次手术、甲状腺恶性疾病侵袭、炎症性甲状腺疾病。初次手术中，暂时性喉返神经损伤率为0。43％，永久性喉返神经损伤率为0．27％。109例次全切除术后的二次手术中，暂时性和永久性喉返神经损伤的损伤概率分别为4．59％及4．59％。甲状腺Ⅲ。肿大者所导致的永久性及暂时性喉返神经损伤概率分别为1．81％和0．30％。甲状腺恶性疾病所致的暂时性喉和永久性喉返神经损伤的损伤概率分别为0．51％和0．72％。炎症性甲状腺疾病暂时性喉返神经损伤概率为1．叭％。结论巨大甲状腺肿会增加术中喉返神经损伤的风险，应考虑适当提前手术时机。对于有手术指征的甲状腺疾病，初次手术根据病变范围最好选用甲状腺全切除术或单侧腺叶全切除术以避免疾病复发后二次手术损伤喉返神经。

Objective To investigate the mechanism of recurrent laryngeal nerve injury during total thyroidectomy. Methods The clinical data of 36 patients suffering from recurrent laryngeal nerve injury in total thyroidectomy from 2003 to 2014 was analyzed retrospectively. Results 21 cases had temporary recurrent laryngeal nerve injury while 16 cases had permanent injury. The cases of injury included giant thyroid goitre, with variation of recurrent laryngeal nerve, undergoing secondary surgery, with tumor invasion and complicating thyroiditis. During the first surgery, the incidence of temporary recurrent laryngeal nerve injury was 0. 43% , and the incidence of permanent damage was 0. 27%. The temporary and permanent injury incidence of secondary surgery after initial subtotal thyroidectomy was 4. 59% and 4. 59%, respectively. For patients with grade 3 thyroid gland, that was 1.81% and 0.30%, respectively and 0. 51%, 0.72% respectively in malignant cases. In cases complicating thyroiditis temporary recurrent laryngeal nerve injury occurred in 1.01%. Conclusions There is increased risk of recurrent laryngeal nerve injury in giant goiter cases undergoing secondary operations. Hence it is suggested that initial surgical procedure be hemithyroidectomy or total thyroidectomy