甲状腺手术中喉返神经损伤
Recurrent laryngeal nerve injury in thyroid surgery.
作者信息
Zakaria Hazem M, Al Awad Naif A, Al Kreedes Ali S, Al-Mulhim Abdul Mohsin A, Al-Sharway Mohammed A, Hadi Maha Abdul, Al Sayyah Ahmed A
出版信息
Oman Med J. 2011 Jan;26(1):34-8. doi: 10.5001/omj.2011.09.
OBJECTIVES
Vocal cord paresis or paralysis due to iatrogenic injury of the recurrent laryngeal nerve (RLNI) is one of the main problems in thyroid surgery. Although many procedures have been introduced to prevent the nerve injury, still the incidence of recurrent laryngeal nerve palsy varies between 1.5-14%. The aim of the present study is to assess the risk factors of recurrent laryngeal nerve injury during thyroid surgery.
METHODS
Patients who had thyroid surgery between 1990 and 2005 and were admitted to the surgical department of King Fahd hospital of the University, Al-Khobar, Saudi Arabia were enrolled for this retrospective review, Factors predisposing to recurrent laryngeal nerve injury were evaluated such as pathology of the lesions and the type of operations and identification of recurrent laryngeal nerve intra-operatively. Preoperative and postoperative indirect laryngoscopic examinations were performed for all patients.
RESULTS
340 patients were included in this study. Transient unilateral vocal cord problems occurred in 11 (3.2%) cases, and in 1 (0.3%) case, it became permanent (post Rt. Hemithyroidectomy). Bilateral vocal cord problems occurred in 2 cases (0.58%), but none became permanent. There were significant increases in the incidence of recurrent laryngeal nerve injury in secondary operation (21.7% in secondary vs. 2.8% in primary, p=0.001), total/near total thyroidectomy (7.2% in total vs. 1.9% in subtotal, p=0.024), non-identification of RLN during surgery (7.6% in non-identification vs. 2.6% in identification, p=0.039) and in malignant disease (12.8% in malignant vs. 2.9% in benign, p=0.004). However, there was no significant difference in the incidence of recurrent laryngeal nerve injury with regards to gender (4.1% in male vs 3.8% in female, p=0.849).
CONCLUSION
The present study showed that thyroid carcinoma, re-operation for recurrent goiter, non-identification of RLN and total thyroidectomy were associated with a significantly increased risk of operative recurrent laryngeal nerve injury.
目的
因喉返神经（RLNI）医源性损伤导致的声带麻痹或瘫痪是甲状腺手术中的主要问题之一。尽管已引入多种手术方法来预防神经损伤，但喉返神经麻痹的发生率仍在1.5%至14%之间。本研究的目的是评估甲状腺手术中喉返神经损伤的危险因素。
方法
选取1990年至2005年间在沙特阿拉伯胡拜尔法赫德国王大学医院外科接受甲状腺手术的患者进行这项回顾性研究，评估易导致喉返神经损伤的因素，如病变的病理类型、手术方式以及术中喉返神经的识别情况。对所有患者进行术前和术后间接喉镜检查。
结果
本研究共纳入340例患者。11例（3.2%）出现短暂性单侧声带问题，1例（0.3%）（右半甲状腺切除术后）变为永久性问题。2例（0.58%）出现双侧声带问题，但均未变为永久性。二次手术中喉返神经损伤的发生率显著增加（二次手术为21.7%，首次手术为2.8%，p = 0.001），全甲状腺切除/近全甲状腺切除术中（全甲状腺切除术为7.2%，次全甲状腺切除术为1.9%，p = 0.024），手术中未识别喉返神经（未识别组为7.6%，识别组为2.6%，p = 0.039）以及恶性疾病患者中（恶性疾病患者为12.8%，良性疾病患者为2.9%，p = 0.004）。然而，喉返神经损伤的发生率在性别方面无显著差异（男性为4.1%，女性为3.8%，p = 0.849）。
结论
本研究表明，甲状腺癌、复发性甲状腺肿再次手术、未识别喉返神经以及全甲状腺切除术与手术中喉返神经损伤风险显著增加相关。
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