Miyauchi Akira, Inoue Hiroyuki, Tomoda Chisato, Fukushima Mitsuhiro, Kihara Minoru, Higashiyama Takuya, Takamura Yuuki, Ito Yasuhiro, Kobayashi Kaoru, Miya Akihiro
Department of Surgery, Kuma Hospital, Kobe, Japan.
Surgery. 2009 Dec;146(6):1056-62. doi: 10.1016/j.surg.2009.09.018.
We report vocal improvement after reconstruction of the recurrent laryngeal nerve (RLN) in patients with nerve resection, although vocal cord movement was not restored. These methods are not widely recognized.
Direct anastomosis, free nerve grafting, or anastomosis to the ansa cervicalis or the vagus nerves with the RLN were performed in 7, 14, 65, and 2 patients with thyroid cancer invading the RLN, respectively. A total of 51 patients had vocal cord paralysis (VCP) pre-operatively. Maximum phonation time (MPT) and vital capacity (VC) were measured before and 1 year after reconstruction. A total of 34 normal subjects and 27 patients with VCP served as controls.
Patients with VCP had significantly shorter MPT values than normal subjects. At 1 year after operation, patients with reconstruction had values of MPT similar to those of normal subjects. Men had significantly longer MPT values than women, but the phonation efficiency index (PEI), defined as the MPT/VC ratio, did not differ by sex. The PEI was significantly less in VCP patients than in normal subjects. Patients with reconstruction achieved PEI values similar to those in normal subjects. Phonation efficiency index values at 1 year after operation was significantly greater than pre-operative PEI and was not affected by the presence or absence of VCP pre-operatively, age, reconstruction method, thickness of suture thread, or use of magnification during the operation.
In patients with thyroid cancer requiring RLN resection, RLN reconstruction achieved recovery in phonatory function.
我们报告了在喉返神经（RLN）切除的患者中，尽管声带运动未恢复，但在喉返神经重建后声音得到改善。这些方法尚未得到广泛认可。
分别对7例、14例、65例和2例因甲状腺癌侵犯喉返神经的患者进行了直接吻合、游离神经移植或与喉返神经吻合至颈袢或迷走神经的手术。共有51例患者术前存在声带麻痹（VCP）。在重建前及重建后1年测量最大发声时间（MPT）和肺活量（VC）。共有34名正常受试者和27例VCP患者作为对照。
VCP患者的MPT值明显短于正常受试者。术后1年，重建患者的MPT值与正常受试者相似。男性的MPT值明显长于女性，但发声效率指数（PEI），即MPT/VC比值，在性别上没有差异。VCP患者的PEI明显低于正常受试者。重建患者的PEI值与正常受试者相似。术后1年的发声效率指数值明显高于术前PEI，且不受术前是否存在VCP、年龄、重建方法、缝线厚度或手术中是否使用放大镜的影响。
在需要切除喉返神经的甲状腺癌患者中，喉返神经重建实现了发声功能的恢复。
