Weitensfelder W, Lexer G, Aigner H, Fellinger H, Trattnig J, Grünbacher G
Allgemeinchirurgischen Abteilung, LKH Klagenfurt.
Zentralbl Chir. 1989;114(9):583-9.
17 of 525 patients (3.2%) showed an laryngoscopically established palsy of the recurrent laryngeal nerve after surgery for struma. The analysis of these operations, performed by five surgeons during or within three years after the period of surgical training, revealed that the operations performed under assistance of the senior surgeons were high grade selected (p = 0.026). Thus 14.8% of the operations performed because of simple goiter but only 4.8% of the operations performed because of thyroid cancer/recurrent goiter/extensive nodular goiter were assisted in this way. On the other hand it was necessary to call for help of a senior surgeon because of intraoperative difficulties in only 1.26% of the cases operated on for simple goiter, but in 19.6% of the more complex forms of goiter (p less than 0.001). The risk of recurrent laryngeal nerve palsy was nearly 10 times higher in the complex forms of goiter than in the simple forms (p less than 0.001). More extensive surgical training in the forms of complex goiters should be able to improve the results.
525例患者中有17例（3.2%）在甲状腺肿手术后经喉镜检查证实出现喉返神经麻痹。对5位外科医生在手术培训期间或培训后3年内进行的这些手术进行分析发现，在资深外科医生协助下进行的手术属于高难度选择（p = 0.026）。因此，因单纯性甲状腺肿而进行的手术中有14.8%得到了这种协助，而因甲状腺癌/复发性甲状腺肿/广泛性结节性甲状腺肿而进行的手术中只有4.8%得到了这种协助。另一方面，因术中困难而需要资深外科医生帮助的情况，在单纯性甲状腺肿手术中仅占1.26%，而在更复杂类型的甲状腺肿手术中占19.6%（p < 0.001）。复杂类型甲状腺肿手术中喉返神经麻痹的风险几乎是单纯类型的10倍（p < 0.001）。对复杂类型甲状腺肿手术进行更广泛的外科培训应该能够改善手术效果。
