甲状腺良性病变手术与喉返神经损伤

Relationship between thyroidectomy patterns and injury of recurrent laryngeal nerve in benign thyroid neoplasms

目的 探讨甲状腺良性病变的手术致喉返神经(recurrent laryngeal nerve,RLN)损伤的主要相关因素。方法回顾分析586例甲状腺良性病变的手术资料,探讨RLN损伤与手术方式、RLN在手术中是否预先分离保护的关系。结果586例手术病人发生RLN损伤者为34例,占5.80％,其中以甲状腺次全切除术RLN受损率最高,占88.24％(30/34);术中明确预先解剖出RLN并予以保护者,术后暂时声带麻痹的发生率为0.91％,无永久性声带麻痹。结论 甲状腺次全切除术RLN损伤率最高,可能与缝合殁体时RLN被误伤有关。术中先行游离RLN并予以保护,缝合甲状腺残体时,应尽量在食管沟平面以上注意保留后包膜的完整是减少医源性RLN损伤的重要措施。

Objective To study the relationship between the thyroidectomy patterns and injury of the recurrent laryngeal nerve (RLN) in patients with benign thyroid neoplasms. Methods Five hundred eighty and six patients with benign thyroid neoplasms were treated by surgery from January 1995 to December 2002. There were 153 males and 433 females, ranging in age from 15 to 65 years old. In 486 patients, subtotal thyroidectomy was 356, partial thyroidectomy 152 and neoplasm resection alone 78. The factors of paralysis of RLN were analyzed. Results Injury incidence of RLN was 5.80 % (34 / 586) in all surgery patients. The rate of paralysis of RLN was higher in subtotal thyroidectomy (88.24 %, 30/34) than that in partial thyroidectomy (11.76 %, 4 / 34) (P< 0.05). Conclusion The incidence of injury of RLN is related with the patterns of thyroidectomy. The incidence of injury of RLN is highest in subtotal thyroidectomy patients.The anatomy of RLN and identification in the procedure of thyroidectomy would be avoid to the paralysis of RLN.