甲状腺手术单侧喉返神经损伤类型和临床表现分析

Analysis on the Types and Symptoms of Unilateral Recurrent Laryngeal Nerve Injury Associated of Thyroid Surgery

目的探讨甲状腺手术患者喉返神经不同损伤类型的临床表现。方法回顾性收集2015年1月~2018年6月于首都医科大学附属北京友谊医院普外科行甲状腺手术患者1687例,术中IONM证实单侧喉返神经损伤且随访86例,男性18例,女性68例,年龄14~78岁,平均年龄(48.66±13.01)岁;甲状腺癌68例,结节性甲状腺肿16例,桥本氏甲状腺炎2例。行双侧甲状腺全切术45例,甲状腺腺叶切除术41例。分析术后声音嘶哑、饮水呛咳恢复情况。结果86例患者中横断损伤占26.7%(23/86),非横断损伤占73.3%(63/86)。64%(55/86)的患者术后出现不同程度的声音嘶哑和(/或)饮水呛咳的症状,其中横断伤患者15例(65.2%),非横断伤患者40例(63.5%),两者比较差异无统计学意义(P>0.05)。结论单侧喉返神经损伤后,横断损伤与非横断损伤主要临床表现均可为声音嘶哑、饮水呛咳,也可无明显临床表现。在未使用IONM技术的情况下喉返神经损伤率可能被低估。

Objective To explore the clinical manifestations and symptoms of different types of recurrent laryngeal nerve(RLN)injury in thyroid surgery.Methods Retrospectively collected 1687 cases of thyroid surgery at general surgery department of Beijing Friendship Hospital,Capital Medical University from January 2015 to June 2018,of which 86 cases of unilateral RLN injury were confirmed by IONM during operation,including 18 males and 68 females,aged 14 to 78 years,with an average age of(48.66±13.01)years.There were 68 cases of thyroid cancer,16 cases of nodular goiter and 2 cases of Hashimoto's thyroiditis.Bilateral total thyroidectomy was performed in 45 cases and thyroid lobectomy in 41 cases.The postoperative hoarseness and chockingcough was analyzed.Results Of the 86 patients with RLN injury,26.7%(23/86)was transverse injury and 73.3%(63/86)was non-transverse injury.There were 55 cases(64%)appeared hoarseness and/or chocking cough after operation,including 15 cases(65.2%)of transverse injury and 40 cases(63.5%)of non-transverse injury.There was no significant difference between the two groups(P>0.05).Conclusions The main clinical manifestations of unilateral RLN injury are hoarseness,chocking cough and no clinical manifestations.Therefore,the incidence of RLN injury would be underestimated without application of IONM technique.