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甲状腺切除术后喉返神经麻痹的差异发生率

Differential recurrent laryngeal nerve palsy rates after thyroidectomy.

作者信息

Serpell Jonathan W, Lee James C, Yeung Meei J, Grodski Simon, Johnson William, Bailey Michael

机构信息

Monash University Endocrine Surgery Unit and Alfred Hospital, Melbourne, Victoria, Australia.

Monash University Endocrine Surgery Unit and Alfred Hospital, Melbourne, Victoria, Australia.

出版信息

Surgery. 2014 Nov;156(5):1157-66. doi: 10.1016/j.surg.2014.07.018. Epub 2014 Oct 17.

Abstract

INTRODUCTION

Recurrent laryngeal nerve (RLN) palsy is a devastating complication of thyroidectomy. Although neurapraxia is thought to be the most common cause, the underlying mechanisms are poorly understood. The objectives of this study were to examine the differential palsy rates between the left and right RLNs, and the role of intraoperative nerve swelling as a risk factor of postoperative palsy.

METHODS

Thyroidectomy data were collected, including demographics, change in RLN diameter, and RLN electromyographic (EMG) reading. Left and right RLNs, as well as bilateral and unilateral subgroup analyses were performed.

RESULTS

A total of 5,334 RLNs were at risk in 3,408 thyroidectomies in this study. The overall RLN palsy rate was 1.5%, greater on the right side than the left for bilateral cases (P = .025), and greater on the left side than the right for unilateral cases (P = .007). In a subgroup of 519 RLNs, the diameter and EMG amplitude were measured. The RLN diameter increased by approximately 1.5-fold (P < .001), and corresponded to increased EMG amplitude (P = .01) during the procedure. The diameter of the right RLN was larger than the left RLN, both at the beginning and end of the dissection (P = .001).

CONCLUSION

The right-left differential rates of post-thyroidectomy RLN palsy seemed to be due in part to differential RLN diameters, with stretch having a more deleterious effect on RLNs with a smaller diameter; also, edema as a result of stretch might be an underlying mechanism for postoperative neurapraxia and palsy. Thyroid surgeons should be aware of the different vulnerabilities of each RLN and develop practices to avoid iatrogenic injury.

摘要

引言

喉返神经(RLN)麻痹是甲状腺切除术的一种严重并发症。尽管神经失用被认为是最常见的原因,但其潜在机制仍知之甚少。本研究的目的是检查左右喉返神经之间的麻痹差异率,以及术中神经肿胀作为术后麻痹危险因素的作用。

方法

收集甲状腺切除术数据,包括人口统计学、喉返神经直径变化和喉返神经肌电图(EMG)读数。对左右喉返神经以及双侧和单侧亚组进行分析。

结果

本研究中,3408例甲状腺切除术中共有5334条喉返神经面临风险。总体喉返神经麻痹率为1.5%,双侧病例右侧高于左侧(P = 0.025),单侧病例左侧高于右侧(P = 0.007)。在519条喉返神经的亚组中,测量了直径和EMG振幅。术中喉返神经直径增加了约1.5倍(P < 0.001),且与EMG振幅增加相对应(P = 0.01)。在解剖开始和结束时,右侧喉返神经的直径均大于左侧(P = 0.001)。

结论

甲状腺切除术后喉返神经麻痹的左右差异率似乎部分归因于喉返神经直径的差异,拉伸对直径较小的喉返神经具有更有害的影响;此外,拉伸导致的水肿可能是术后神经失用和麻痹的潜在机制。甲状腺外科医生应意识到每条喉返神经的不同易损性,并制定避免医源性损伤的操作方法。

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