Ahmed Maqbool, Abbas Safdar, Boota Muhammad, Ashfaq Muhammad, Rashid Asif Zaman, Qureshi Muhammad Azhar, Iqbal Nauman
Department of Surgery, Military Hospital, Street 8, Valley Road, Rawalpindi.
J Coll Physicians Surg Pak. 2013 Mar;23(3):186-9.
To compare the frequency of recurrent laryngeal nerve(s) (RLNs) palsy after various thyroid procedures with and without identification of recurrent laryngeal nerve during the operation.
Randomized controlled trial.
Department of Surgery, Military Hospital, Rawalpindi, from August 2008 to April 2010.
Patients undergoing indirect laryngoscopy with normal vocal cords and those with carcinoma and re-do surgery having normal vocal cord were included in the study. Patients with hoarseness of voice, abnormal vocal cord movements and with solitary nodule in the isthmus were excluded. These patients were randomly divided into 2 groups of 50 each using random number tables. RLN was identified by exposing the inferior thyroid artery and traced along its entire course in group-A. Whereas, in group-B, nerves were not identified during the operations. Immediate postoperative direct laryngoscopy was performed by a surgeon with the help of an anaesthesiologist for the assessment of vocal cords. Patients with persistent hoarseness of voice were followed-up with indirect laryngoscopy at 3 and 6 months.
Temporary unilateral recurrent laryngeal nerve palsies occurred in 2 (4%) patients in group-A where the voice and cord movements returned to normal in 6 months. In group-B, it occurred in 8 (16%) patients, 2 bilateral (4%) injuries requiring tracheostomy and 6 unilateral injuries (12%). Among the 2 bilateral recurrent laryngeal nerve injuries, the tracheostomy was removed in one case after 6 months with persistent hoarseness of voice but no respiratory difficulty during routine activities. Tracheostomy was permanent in the other case. Among the 6 cases of unilateral nerve injuries, the voice improved considerably in 4 cases within 6 months but in 2 cases hoarseness persisted even after 6 months. Frequency of recurrent laryngeal nerve palsies was significantly lower in group-A as compared to group-B (p = 0.046).
For safe thyroid surgery, recurrent laryngeal nerve(s) should be routinely exposed in its entire course.
比较在手术中识别与未识别喉返神经的情况下，各种甲状腺手术术后喉返神经麻痹的发生率。
随机对照试验。
2008年8月至2010年4月，拉瓦尔品第军事医院外科。
研究纳入间接喉镜检查显示声带正常的患者，以及患有癌症且再次手术时声带正常的患者。排除声音嘶哑、声带运动异常以及峡部有孤立结节的患者。使用随机数字表将这些患者随机分为两组，每组50例。A组通过暴露甲状腺下动脉并沿其全程追踪来识别喉返神经。而在B组手术过程中未识别神经。术后立即由外科医生在麻醉医生的协助下进行直接喉镜检查以评估声带。声音持续嘶哑的患者在3个月和6个月时接受间接喉镜检查随访。
A组有2例（4%）患者发生暂时性单侧喉返神经麻痹，6个月时声音和声带运动恢复正常。B组有8例（16%）患者发生，其中2例双侧（4%）损伤需要气管切开术，6例单侧损伤（12%）。在2例双侧喉返神经损伤中，1例在6个月后气管切开术移除，但声音持续嘶哑，日常活动中无呼吸困难。另一例气管切开术为永久性。在6例单侧神经损伤中，4例在6个月内声音明显改善，但2例即使6个月后仍持续嘶哑。A组喉返神经麻痹的发生率显著低于B组（p = 0.046）。
为了安全进行甲状腺手术，应常规全程暴露喉返神经。
