Sarkis Leba M, Zaidi Nisar, Norlén Olov, Delbridge Leigh W, Sywak Mark S, Sidhu Stan B
Endocrine Surgical Unit, Royal North Shore Hospital, The University of Sydney, Sydney, New South Wales, Australia.
ANZ J Surg. 2017 May;87(5):364-367. doi: 10.1111/ans.12980. Epub 2015 Feb 3.
Bilateral recurrent laryngeal nerve (RLN) palsy following total thyroidectomy is a rare complication, however, poses significant morbidity to the patient when it does occur. The purpose of this paper was to determine the incidence of bilateral RLN palsy in a specialized thyroid unit and determine whether the routine use of intraoperative nerve monitoring (IONM) would alter the outcome.
This is a retrospective review of prospectively gathered data. A total of 7406 patients underwent total thyroidectomy at the University of Sydney Endocrine Surgical Unit between January 1990 and February 2014. IONM was utilized on a selective basis and we sought to assess whether IONM would have altered outcome in those patients who developed bilateral RLN palsy.
Of the 7406 patients who underwent total thyroidectomy, seven patients (0.09%) developed bilateral RLN palsy during the study period. There was one permanent RLN palsy (0.01%) and routine IONM may have prevented one death and altered the outcome in two of the seven patients.
Bilateral RLN palsy is a rare entity occurring in one out of 1000 cases in a specialized thyroid unit. IONM may facilitate the decision to pursue delayed surgery where the signal is lost on the first surgical side and has the potential to avoid bilateral RLN palsy following total thyroidectomy.
全甲状腺切除术后双侧喉返神经（RLN）麻痹是一种罕见的并发症，然而一旦发生，会给患者带来严重的发病率。本文的目的是确定在一个专业甲状腺科室中双侧RLN麻痹的发生率，并确定术中神经监测（IONM）的常规使用是否会改变结果。
这是一项对前瞻性收集数据的回顾性研究。1990年1月至2014年2月期间，悉尼大学内分泌外科共有7406例患者接受了全甲状腺切除术。IONM是选择性使用的，我们试图评估IONM是否会改变那些发生双侧RLN麻痹患者的结果。
在接受全甲状腺切除术的7406例患者中，有7例（0.09%）在研究期间发生了双侧RLN麻痹。有1例永久性RLN麻痹（0.01%），常规IONM可能避免了1例死亡，并改变了7例患者中2例的结果。
双侧RLN麻痹是一种罕见的情况，在专业甲状腺科室中千分之一的病例中会出现。IONM可能有助于在手术一侧信号丢失时决定进行延迟手术，并有可能避免全甲状腺切除术后双侧RLN麻痹。
