Department of Internal Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
J Voice. 2012 Mar;26(2):262-6. doi: 10.1016/j.jvoice.2010.11.007. Epub 2011 Aug 11.
The objective of this study was to evaluate the factors predictive of postoperative laryngeal nerve paresis (LNP) in patients undergoing thyroid surgery. We also assess the implications of preoperative LNP on postoperative vocal fold status.
Case series with retrospective chart review.
Charts of 17 patients who underwent thyroid surgery and had pre- and postoperative laryngeal electromyography (LEMG) were reviewed. LEMGs were ordered routinely in all patients undergoing thyroid surgery, not just in those with clinical findings suggestive of paresis. We collected data relating to pre- and postoperative laryngeal and thyroid evaluations and the details of the surgical procedure. We analyzed the prevalence of preoperative LNP and relationship of thyroid diagnoses, size of thyroid mass, and type of surgery performed with respect to the outcome of the LNP.
All the 17 patients had a mild to moderate degree of unilateral or bilateral LNP preoperatively. However, only seven (41.2%) had vocal symptoms. After surgery, only five of these seven patients had voice complaints, and there were no patients with voice complaints among the group that had been asymptomatic preoperatively. Thyroid diagnoses included 11 cases of benign disease (64.7%) in which LNP improved in two, worsened in four, and remained the same in five; and six cases of malignant disease (35.3%) in which LNP improved in none, worsened in two, and remained the same in four. Predictors of worsening postoperative LNP on LEMG included the diagnosis of goiter (P=0.0005) and size of mass greater than 5cm (0.032).
This study supports the notion that there is an intrinsic relationship between benign thyroid diseases and LNP that is probably related to local effects of the disease on the laryngeal nerves. All patients with the postoperative diagnosis of goiter worsened, and all patients with the postoperative diagnosis of adenoma showed no change on postoperative electromyography (EMG). Similarly, all patients with the diagnosis of thyroiditis alone improved, and there were no cases of improvement outside this group. Of the six cases of malignancy, four exhibited no change on EMG and only two worsened. The only reliable predictors of worsening paresis postoperatively are mass size greater than 5cm and diagnosis of goiter.
本研究旨在评估甲状腺手术患者术后喉返神经麻痹（LNP）的预测因素。我们还评估了术前 LNP 对术后声带状态的影响。
病例系列回顾性研究。
回顾了 17 例接受甲状腺手术且术前和术后均行喉肌电图（LEMG）检查的患者的病历。所有接受甲状腺手术的患者均常规行 LEMG 检查，而不仅仅是那些有麻痹体征的患者。我们收集了与术前和术后喉部及甲状腺评估以及手术过程详细信息相关的数据。我们分析了术前 LNP 的患病率以及甲状腺诊断、甲状腺肿块大小和手术类型与 LNP 结果的关系。
所有 17 例患者术前均有单侧或双侧 LNP，程度为轻至中度。然而，只有 7 例（41.2%）有嗓音症状。手术后，仅有 7 例有嗓音主诉的患者中有 5 例出现嗓音主诉，而术前无症状的患者中没有出现嗓音主诉的患者。甲状腺诊断包括 11 例良性疾病（64.7%），其中 LNP 改善 2 例，恶化 4 例，不变 5 例；6 例恶性疾病（35.3%），其中 LNP 无改善 2 例，恶化 2 例，不变 4 例。LEMG 检查提示术后 LNP 恶化的预测因素包括甲状腺肿诊断（P=0.0005）和肿块大于 5cm（0.032）。
本研究支持这样一种观点，即良性甲状腺疾病与 LNP 之间存在内在联系，这种联系可能与疾病对喉返神经的局部影响有关。所有术后诊断为甲状腺肿的患者均恶化，所有术后诊断为腺瘤的患者在术后肌电图（EMG）上均无变化。同样，所有单独诊断为甲状腺炎的患者均有改善，且无一例在该组之外有改善。在 6 例恶性肿瘤中，有 4 例 EMG 无变化，仅有 2 例恶化。术后神经麻痹恶化的唯一可靠预测因素是肿块大于 5cm 和甲状腺肿的诊断。
