Koyanagi Kazuo, Igaki Hiroyasu, Iwabu Jun, Ochiai Hiroki, Tachimori Yuji
Division of Esophageal Surgery, Department of Gastrointestinal Oncology, National Cancer Center Hospital.
Tohoku J Exp Med. 2015 Sep;237(1):1-8. doi: 10.1620/tjem.237.1.
Recurrent laryngeal nerve paralysis (RLNP) after esophagectomy is a common complication and associated with aspiration pneumonia. In this study, we assessed the risk of RLNP and the usefulness of immediate reconstruction of recurrent laryngeal nerve (RLN) to prevent respiratory complications after esophagectomy. Seven hundred and eighty-two consecutive patients underwent an esophagectomy with three-field lymph node dissection, simultaneous gastric conduit reconstruction, and cervical anastomosis. Vocal cord function was observed using a flexible laryngoscope. Reconstruction between RLN and ipsilateral vagus nerve was performed during esophagectomy. RLNP was observed in 229 (29.3%) of the patients after esophagectomy: 198 unilateral and 31 bilateral cases. Of the 198 unilateral RLNP, vocal cord paralysis was observed predominantly on the left side (82.7%). RLNP was significantly associated with postoperative respiratory complications (P < 0.001) requiring a tracheotomy (P < 0.001) and mechanical ventilation (P < 0.001) and was also associated with esophagogastric anastomotic leakage (P = 0.015); consequently, the postoperative hospital stay was longer for patients with RLNP (P < 0.001). A longer operation time (P < 0.001) and advanced age (P = 0.038) were identified as significant independent predictors of RLNP. Resection of the RLN together with metastatic nodes was performed in 29 cases. The patients underwent RLN reconstruction (n = 11) had a significantly shorter postoperative hospital stay than those without RLN reconstruction (n = 18) (P = 0.019). In conclusion, RLNP was related to a poorer postoperative course among patients undergoing an esophagectomy. New surgical technologies are recommended for prevention of RLNP.
食管癌切除术后喉返神经麻痹(RLNP)是一种常见并发症,与吸入性肺炎相关。在本研究中,我们评估了RLNP的风险以及即刻重建喉返神经(RLN)对预防食管癌切除术后呼吸并发症的有效性。782例连续患者接受了食管癌切除、三野淋巴结清扫、同期胃代食管重建及颈部吻合术。使用可弯曲喉镜观察声带功能。在食管癌切除术中进行RLN与同侧迷走神经之间的重建。食管癌切除术后229例(29.3%)患者出现RLNP:198例单侧和31例双侧病例。在198例单侧RLNP中,声带麻痹主要发生在左侧(82.7%)。RLNP与术后呼吸并发症(P<0.001)、需要气管切开(P<0.001)和机械通气(P<0.001)显著相关,也与食管胃吻合口漏(P=0.015)相关;因此,RLNP患者的术后住院时间更长(P<0.001)。较长的手术时间(P<0.001)和高龄(P=0.038)被确定为RLNP的重要独立预测因素。29例患者进行了RLN连同转移淋巴结的切除。接受RLN重建的患者(n=11)术后住院时间明显短于未进行RLN重建的患者(n=18)(P=0.019)。总之,RLNP与食管癌切除患者较差的术后病程相关。建议采用新的手术技术预防RLNP。