Iacobone Maurizio, Viel Giovanni, Zanella Simone, Bottussi Marzia, Frego Mauro, Favia Gennaro
Endocrine Surgery Department, University of Padua, Italy, Via Giustiniani 2, 35128, Padova, Italy.
Langenbecks Arch Surg. 2008 Sep;393(5):633-8. doi: 10.1007/s00423-008-0372-9. Epub 2008 Jul 5.
Nonrecurrent inferior laryngeal nerve (ILN) represents a risk factor for injury during neck surgery. It is associated to arterial abnormalities (absence of the brachiocephalic trunk and arteria lusoria) that can be identified by ultrasonography. The aim of the study was to verify the usefulness of preoperative ultrasonography in the research of nonrecurrent ILN by the means of identification of arterial abnormalities and the impact on ILN morbidity.
The study included 750 patients who underwent neck surgery with right-side ILN dissection. A preoperative ultrasonography aimed to identify arterial abnormalities associated to nonrecurrent ILN was performed in 400 patients (Group A) while no preoperative attempts were performed in the remaining patients (Group B). Patients' characteristics, time for intraoperative identification of the ILN, and morbidity were compared.
Five and four nonrecurrent ILN were identified in groups A and B, respectively (p = NS). Preoperative ultrasonography correctly predicted nonrecurrent ILN in all cases (accuracy 100%). Nonrecurrent ILN palsy never occurred in group A, while three cases occurred in group B (p < 0.05). The mean time for intraoperative identification of both nonrecurrent and normally recurrent ILN was significantly shorter in group A (p < 0.01).
Preoperative ultrasonography can correctly identify nonrecurrent ILN, allowing earlier nerve identification and prevention of injuries.
非折返性喉返神经（ILN）是颈部手术中损伤的一个危险因素。它与动脉异常（头臂干缺如和迷走动脉）相关，这些异常可通过超声检查识别。本研究的目的是通过识别动脉异常来验证术前超声检查在非折返性ILN研究中的实用性以及对喉返神经发病率的影响。
本研究纳入了750例行右侧喉返神经解剖颈部手术的患者。400例患者（A组）进行了旨在识别与非折返性喉返神经相关的动脉异常的术前超声检查，而其余患者（B组）未进行术前检查。比较了患者的特征、术中识别喉返神经的时间和发病率。
A组和B组分别识别出5例和4例非折返性喉返神经（p = 无显著性差异）。术前超声检查在所有病例中均正确预测了非折返性喉返神经（准确率100%）。A组未发生非折返性喉返神经麻痹，而B组发生了3例（p < 0.05）。A组术中识别非折返性和正常折返性喉返神经的平均时间明显更短（p < 0.01）。
术前超声检查可正确识别非折返性喉返神经，有助于更早地识别神经并预防损伤。
