Chiang Feng-Yu, Lin Jen-Chih, Lee Ka-Wo, Wang Ling-Feng, Tsai Kuo-Bow, Wu Che-Wei, Lu Shang-Pin, Kuo Wen-Rei
Department of Otolaryngology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
Surgery. 2006 Sep;140(3):413-7. doi: 10.1016/j.surg.2006.02.006.
The aim of this present study is to define the significance of recurrent laryngeal nerve palsy (RLNP) detected before surgery for thyroid diseases with regard to the incidence of malignancy, histopathologic distribution, extrathyroidal invasion, management, and prognosis.
Six hundred and twenty-two patients underwent operation for various thyroid disease and were treated by the same surgeon. The study was confined to 16 (3%) patients who suffered from a thyroid tumor with preoperative RLNP.
Of these 16 patients, 1 had benign thyroid disease, while the other 15 had malignancy (94%). Among the 15 cancer patients, 14 had extrathyroidal invasion and needed more extensive surgical procedures than total thyroidectomy. The recurrent laryngeal nerve could be dissected from the thyroid neoplasm in 3 patients, 2 of whom experienced recovery of this nerve's function postoperatively.
Thyroid tumor associated with RLNP is strongly suggestive of malignancy. The RLN should be preserved if it has not been invaded by the tumor, because it offers a good chance of functional recovery postoperatively. Well-differentiated thyroid cancer accounts for only half of these patients who tend to present at an older age and feature a much higher incidence of upper aerodigestive tract invasion. The operations for these patients often are complex and should be performed by experienced surgeons. Radical excision of a resectable anaplastic or squamous cell carcinoma of the thyroid gland offers the chance, albeit small, of long-term survival in this study.
本研究的目的是明确在甲状腺疾病手术前检测到的喉返神经麻痹（RLNP）在恶性肿瘤发生率、组织病理学分布、甲状腺外侵犯、治疗及预后方面的意义。
622例因各种甲状腺疾病接受手术的患者由同一位外科医生治疗。本研究局限于16例（3%）术前患有甲状腺肿瘤且伴有RLNP的患者。
这16例患者中，1例患有良性甲状腺疾病，其余15例（94%）患有恶性肿瘤。在15例癌症患者中，14例有甲状腺外侵犯，需要比全甲状腺切除术更广泛的手术操作。3例患者的喉返神经可从甲状腺肿瘤中分离出来，其中2例术后该神经功能恢复。
与RLNP相关的甲状腺肿瘤强烈提示为恶性肿瘤。如果肿瘤未侵犯喉返神经，应予以保留，因为其术后功能恢复的机会较大。分化良好的甲状腺癌仅占这些患者的一半，这些患者往往年龄较大，上呼吸道消化道侵犯的发生率更高。这些患者的手术通常较为复杂，应由经验丰富的外科医生进行。在本研究中，对可切除的甲状腺间变性癌或鳞状细胞癌进行根治性切除虽机会渺茫，但仍能带来长期生存的可能。
