甲状腺腺叶切除术中喉返神经牵拉损伤的原因及对策分析

Analysis of the causes and countermeasures of the retraction injury of the recurrent laryngeal nerve in thyroidectomy

目的探讨甲状腺腺叶切除手术过程中,牵拉导致喉返神经损伤的原因及其对策。方法回顾性分析2016年7月～2017年12月,我院278例腺叶切除过程中被神经监测证实的喉返神经牵拉损伤的病例资料。结果共计损伤13例,被神经监测证实为腺叶切除过程中牵拉损伤9例,其中瞬间牵拉伤3例,持续牵拉伤5例,不明牵拉原因1例;损伤左侧7例,右侧2例;引起损伤的牵拉部位:下极4例,Berry韧带3例,入喉点1例,不明1例;术后出现不同程度声带检查异常,声音沙哑在2～9周后恢复。结论在甲状腺腺叶切除术中,使用神经监测仪,必要时术者与解剖的喉返神经同侧站位,注意术中操作技巧以及避免瞬间的暴力牵拉动作,可减少相应的喉返神经损伤发生。

OBJECTIVE To explore the causes of recurrent laryngeal nerve（RLN） stretching injury and its countermeasures during the thyroidectomy. METHODS The RLN stretching injury confirmed by intraoperative neuromonitoring（IONM） in 278 cases underwent thyroidectomy from July 2016 to December 2017 were reviewed retrospectively. RESULTS A total of 13 RLN were injured, and 9 cases were confirmed to be stretching injury by IONM during the procedure of thyroidectomy, including 3 cases of instant pull, 5 cases of sustained traction, and 1 case unknown. The nerves were injured on the left side in 7 cases and right side in 2 cases. The pull position were in the lower pole in 4 cases, Berry ligament 3 cases, RLN entry point 1 case and unknown in 1 case. The abnormal movement of the vocal cords in different degree was found in those patients after operation and the hoarseness voice were recovered after 2 to 9 weeks. CONCLUSION During the thyroidectomy, the use of IONM, standing on the same side of the RLN, paying more attention to the intraoperative techniques and avoiding violent action, may reduce the RLN injury.