Friedrich T, Hänsch U, Eichfeld U, Steinert M, Schönfelder M
Chirurgische Klinik I, Allgemeine Chirurgie, Chirurgische Onkologie und Thoraxchirurgie, Universität Leipzig.
Zentralbl Chir. 2000;125(2):137-43.
Bilateral vocal cord paralysis is a rare but potentially dangerous postoperative complication in thyroid gland surgery. There is a controversial discussion about therapeutic management of postoperative bilateral vocal cord paralysis.
We analysed the frequency of bilateral nerve palsy in 985 operations. The disease of thyroid gland, the operative procedure, the exposure of laryngeal nerve, the mobility of vocal cord detected by an otolaryngologist, clinical symptoms and therapy of patients with bilateral paralysis were analysed. All patients were examined immediately postoperatively and 5 days, 14 days, 6 and 12 months after resection.
The overall transient bilateral palsy rate was 0.7%, the permanent 0.3%. The palsy rate depended on the disease of thyroid gland. After resection of simple goitre we found a 0.2% transient injury rate (0.1% permanent), after operation of thyroid cancer 2.0% transient (1.0% permanent) and in cases of recurrent goitre 5.9% transient (1.9% permanent) palsies. The immediate postoperative symptoms are also very different. There are patients suffering from stridor and dyspnoea, patients with dysphonia without dyspnoea and those without any symptoms. These different clinical symptoms are due to the different grade of laryngeal nerve damage and the resulting position of vocal cords. The bilateral paralysis was completely temporary in 4 cases. 12 months later 4 patients suffered from dysphonia. Only in 3 patients with thyroid cancer and a preoperative unilateral vocal cord paralysis tracheostomy was necessary after operation. The vocal cord mobility did not recover in these 3 cases after 12 months and the patients are not decannulated.
Bilateral paralysis is only relevant in thyroid cancer and recurrent goitre. The symptoms varies and no patient should leave the hospital without examination of the vocal cords by an otolaryngologist. Because vocal cord paralysis is temporary in most cases an emergency tracheostomy is seldom indicated.
双侧声带麻痹是甲状腺手术中一种罕见但潜在危险的术后并发症。关于术后双侧声带麻痹的治疗管理存在争议性讨论。
我们分析了985例手术中双侧神经麻痹的发生率。对甲状腺疾病、手术操作、喉返神经暴露情况、耳鼻喉科医生检测到的声带活动度、双侧麻痹患者的临床症状及治疗进行了分析。所有患者在术后即刻、术后5天、14天、6个月和12个月进行检查。
总体暂时性双侧麻痹发生率为0.7%，永久性为0.3%。麻痹发生率取决于甲状腺疾病。切除单纯性甲状腺肿后，我们发现暂时性损伤率为0.2%（永久性为0.1%），甲状腺癌手术后为2.0%（永久性为1.0%），复发性甲状腺肿病例中暂时性麻痹为5.9%（永久性为1.9%）。术后即刻症状也有很大差异。有出现喘鸣和呼吸困难的患者，有声嘶但无呼吸困难的患者，还有无症状的患者。这些不同的临床症状是由于喉返神经损伤程度不同以及由此导致的声带位置不同。4例双侧麻痹完全是暂时性的。12个月后，4例患者出现声嘶。仅3例甲状腺癌且术前有单侧声带麻痹的患者术后需要气管切开。这3例患者术后12个月声带活动度未恢复且未脱管。
双侧麻痹仅在甲状腺癌和复发性甲状腺肿中具有相关性。症状各不相同，没有患者在未经耳鼻喉科医生检查声带的情况下应出院。由于大多数情况下声带麻痹是暂时性的，很少需要紧急气管切开。
