颈襻前根修复单侧喉返神经损伤的疗效分析

The efficacy of ansa cervicalis anterior root for unilateral recurrent laryngeal nerve injury

目的探讨颈襻前根喉返神经吻合术治疗甲状腺手术所致喉返神经损伤引起单侧声带麻痹（unilateral vocal fold paralysis；UVFP）的远期疗效。方法前瞻性研究2010年1月至2016年1月海军军医大学附属长海医院耳鼻咽喉头颈外科甲状腺术后单侧声带麻痹施行颈襻前根喉返神经吻合术的患者39例，神经损伤病程6～24个月，另外39名年龄和性别与声带麻痹组相匹配的健康志愿者（均声带正常）作为对照组，采用动态喉镜、嗓音功能主客观分析和喉肌电图检查等评价手术治疗效果，并采用配对样本t检验等方法进行统计学分析。结果动态喉镜结果显示声带麻痹组术后声门闭合度、患侧声带边缘、声带位置、声带黏膜波、声带振动对称性和规律性较术前均有明显改善，差异均有统计学意义（P值均〈0.01），与对照组比较差异则均无统计学意义（P值均〉0.05）；术后嗓音功能的GRBAS评估、嗓音客观分析参数（基频微扰、振幅微扰、噪谐比、最长声时）较术前均有显著改善，其中嗓音客观参数术前/术后值分别为1.68±0.82/0.39±0.27、10.08±2.56/4.58±2.96、0.203±0.216/0.018±0.038、5.96±1.92/17.42±4.11，差异均有统计学意义（P值均〈0.01），术后/对照组值分别为0.39±0.27/0.32±0.19、4.58±2.96/3.32±1.27、0.018±0.038/0.014±0.027、17.42±4.11/18.76±5.29，差异则均无统计学意义（P值均〉0.05）；术后喉肌电图检查结果证实患侧喉肌成功获得充分的神经再支配。结论颈襻前根喉返神经吻合术能使单侧声带麻痹患者的嗓音功能恢复正常，疗效满意，为喉返神经修复提供了一种新的理想的治疗方法。

ObjectiveTo discuss the long-term efficacy of laryngeal reinnervation using the anterior root of the ansa cervicalis in the treatment of unilateral vocal fold paralysis （UVFP） caused by thyroid surgery.MethodFrom January 2010 to January 2016, a total of 39 UVFP patients who underwent ansa cervicalis anterior root-to-recurrent laryngeal nerve （RLN） anastomosis and who had suffered nerve disfunction for 6 to 24 months were enrolled as UVFP group.Another 39 age and gender matched normal subjects served as control group. Videostroboscopy, vocal function assessment （acoustic analysis, perceptual evaluation and maximum phonation time）, and laryngeal electromyography were performed preoperatively and postoperatively for assessing surgery efficacy. Paired sample t test was used for statistical analysis.ResultVideostroboscopic reports indicated that the glottic closure, vocal fold edge, vocal fold position, phase symmetry and regularity were significantly improved in the UVFP group （P〈0.01, respectively, postoperative vs. preoperative）and showed no statistical differences compared to the control group （P〉0.05, respectively）. Both the postoperative GRBAS assessment and acoustic parameters were also significantly improved in the UVFP group, Pre-operative acoustic parameters/Post-operative acoustic parameters were 1.68±0.82/0.39±0.27, 10.08±2.56/4.58±2.96, 0.203±0.216/0.018±0.038, 5.96±1.92/17.42±4.11（P〈0.01, respectively） and Pre-operative acoustic parameters/Post-operative acoustic parameters were 0.39±0.27/0.32±0.19, 4.58±2.96/3.32±1.27, 0.018±0.038/0.014±0.027, 17.42±4.11/18.76±5.29, which showed no statistical differences compared to the control group （P〉0.05, respectively）.ConclusionDelayed laryngeal reinnervation with the anterior root of ansa cervicalis, it can restore the physiological laryngeal phonatory function to the normal or a nearly normal voice quality, which is a feasible and effective approach for the treatment of thyroid surgery-related UVFP.