Sato Yu, Kosugi Shin-ichi, Aizawa Naotaka, Ishikawa Takashi, Kano Yosuke, Ichikawa Hiroshi, Hanyu Takaaki, Hirashima Kotaro, Bamba Takeo, Wakai Toshifumi
World J Surg. 2016 Jan;40(1):129-36. doi: 10.1007/s00268-015-3261-8.
The objectives of this study were to assess the incidence of recurrent laryngeal nerve paralysis (RLNP) using laryngoscopy after esophagectomy for thoracic esophageal carcinoma and to clarify the risk factors influencing postoperative RLNP.
A total of 299 patients who underwent laryngoscopic examination after esophagectomy were retrospectively reviewed. Patients who were found to have postoperative RLNP were followed up every 1–3 months, with a median follow-up period of 3 months. Recovery from paralysis was also evaluated on the basis of each affected nerve. Multivariate analyses using logistic regression were used to identify independent risk factors for RLNP. Cumulative recovery rate was calculated using Kaplan–Meier method.
A total of 178 (59.5%) patients were diagnosed with RLNP by first laryngoscopy [bilateral in 59 (33.1%) patients, right in 15 (8.4%), and left in 104 (58.4%)]. In 206 patients who underwent transthoracic and thoracoscopic esophagectomy, independent risk factors for RLNP were lymph node dissection along the right RLN (odds ratio [OR] 3.01, 95% confidence interval [CI] 1.06–8.54, P = 0.04) and cervical anastomosis (OR 5.94, 95% CI 1.78–19.80, P < 0.01). Cumulative recovery rate from RLNP was 61.7% at 12 months after esophagectomy with 91 nerves eventually recovering from paralysis. Median recovery time was 6 months.
RLNP developed in 60 % of patients after esophagectomy and may be associated with lymphadenectomy around the right RLN and cervical esophageal mobilization. Although 62% of affected nerves recovered within 12 months, great attention should be given when performing these procedures.
本研究的目的是评估胸段食管癌食管切除术后通过喉镜检查喉返神经麻痹（RLNP）的发生率，并阐明影响术后RLNP的危险因素。
回顾性分析299例行食管切除术后接受喉镜检查的患者。术后被发现患有RLNP的患者每1 - 3个月随访一次，中位随访期为3个月。还根据每条受影响的神经评估麻痹的恢复情况。采用逻辑回归进行多因素分析以确定RLNP的独立危险因素。使用Kaplan - Meier法计算累积恢复率。
首次喉镜检查共诊断出178例（59.5%）患者患有RLNP[双侧59例（33.1%），右侧15例（8.4%），左侧104例（58.4%）]。在206例行经胸和胸腔镜食管切除术的患者中，RLNP的独立危险因素是沿右侧喉返神经进行淋巴结清扫（比值比[OR] 3.01，95%置信区间[CI] 1.06 - 8.54，P = 0.04）和颈部吻合（OR 5.94，95% CI 1.78 - 19.80，P < 0.01）。食管切除术后12个月时，RLNP的累积恢复率为61.7%，最终91条神经从麻痹中恢复。中位恢复时间为6个月。
食管切除术后60%的患者发生RLNP，可能与右侧喉返神经周围淋巴结清扫和颈部食管游离有关。尽管62%的受影响神经在12个月内恢复，但在进行这些操作时应给予高度重视。
