[即刻喉返神经重建术治疗侵犯喉返神经的甲状腺癌]

[Immediate recurrent laryngeal nerve reconstruction in the treatment of thyroid cancer invading the recurrent laryngeal nerve].

作者信息

Feng Yun, Yang Dazhang, Liu Dandan, Chen Jian, Bi Qingling, Luo Keqiang

机构信息

Department of Otolaryngology, China-Japan Friendship Hospital, Beijing 100029, China.

Department of Otolaryngology, China-Japan Friendship Hospital, Beijing 100029, China. Email:

出版信息

Zhonghua Zhong Liu Za Zhi. 2014 Aug;36(8):621-5.

PMID:25430031

Abstract

OBJECTIVE

To explore the application of immediate recurrent laryngeal nerve reconstruction in the treatment of thyroid cancer invading the recurrent laryngeal nerve.

METHODS

Ten patients with thyroid cancer invading unilateral recurrent laryngeal nerve underwent radical surgery and immediate recurrent laryngeal nerve reconstruction. The reconstructive surgical approach included recurrent laryngeal nerve decompression surgery, end-to-end anastomosis of the recurrent laryngeal nerve, anastomosis of ansa cervicalis nerve to the recurrent laryngeal nerve, and nerve-muscle pedicle (NMP) technique. Among the ten patients, one underwent nerve decompression, one underwent end-to-end anastomosis of the recurrent laryngeal nerve, seven had anastomosis of ansa cervicalis to recurrent laryngeal nerve, and one case had anastomosis of ansa cervicalis to recurrent laryngeal nerve combined with nerve-muscle pedicle (NMP) technique. The effect of surgery was evaluated by videolaryngoscopy, maximum phonation time (MPT), phonation efficiency index (PEI) and voice assessment. T-test was used in the statistical analysis.

RESULTS

All of the 10 patients had no complications including tumor recurrence and hypoparathyroidism after the surgery. Their hoarseness symptoms were improved, and the patients returned to normal or near-normal voice. Postoperative videolaryngoscopy showed that paralyzed vocal cord returned to normal muscle tone and volume, and the vocal cord vibration and mucosal wave were symmetric and the patients got good glottal closure. The pre- and post-operative maximum phone times of the patients were (4.52 ± 0.89) s and (11.91 ± 1.87) s, respectively (P < 0.01). The pre- and post-operative phonation efficiency indices were (1.37 ± 0.43) s/L and (4.02 ± 1.33) s/L, respectively (P < 0.05).

CONCLUSIONS

In patients with thyroid cancer invading unilateral recurrent laryngeal nerve, immediate recurrent laryngeal nerve reconstruction following radical surgery of thyroid cancer can effectively achieve recovery in phonation function and improve the quality of life of the patients.

摘要

目的

探讨即刻喉返神经重建术在甲状腺癌侵犯喉返神经治疗中的应用。

方法

10例单侧喉返神经受侵的甲状腺癌患者接受了根治性手术及即刻喉返神经重建术。重建手术方式包括喉返神经减压术、喉返神经端端吻合术、颈袢神经与喉返神经吻合术以及神经-肌蒂（NMP）技术。10例患者中，1例行神经减压术，1例行喉返神经端端吻合术，7例行颈袢神经与喉返神经吻合术，1例行颈袢神经与喉返神经吻合术联合神经-肌蒂（NMP）技术。通过电子喉镜、最长发声时间（MPT）、发声效率指数（PEI）及嗓音评估对手术效果进行评价。采用t检验进行统计学分析。

结果

10例患者术后均无肿瘤复发及甲状旁腺功能减退等并发症。患者声音嘶哑症状改善，嗓音恢复正常或接近正常。术后电子喉镜检查显示，麻痹声带恢复正常肌张力及容积，声带振动及黏膜波对称，声门闭合良好。患者术前、术后最长发声时间分别为（4.52±0.89）秒和（11.91±1.87）秒（P<0.01）。术前、术后发声效率指数分别为（1.37±0.43）秒/升和（4.02±1.33）秒/升（P<0.05）。