Henry Brandon Michael, Sanna Silvia, Graves Matthew J, Vikse Jens, Sanna Beatrice, Tomaszewska Iwona M, Tubbs R Shane, Walocha Jerzy A, Tomaszewski Krzysztof A
Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland; International Evidence-Based Anatomy Working Group, Kraków, Poland.
Department of Surgical Sciences, University of Cagliari , Monserrato , Sardinia , Italy.
PeerJ. 2017 Mar 21;5:e3012. doi: 10.7717/peerj.3012. eCollection 2017.
The Non-Recurrent Laryngeal Nerve (NRLN) is a rare embryologically-derived variant of the Recurrent Laryngeal Nerve (RLN). The presence of an NRLN significantly increases the risk of iatrogenic injury and operative complications. Our aim was to provide a comprehensive meta-analysis of the overall prevalence of the NRLN, its origin, and its association with an aberrant subclavian artery.
Through March 2016, a database search was performed of PubMed, CNKI, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science. The references in the included articles were also extensively searched. At least two reviewers judged eligibility and assessed and extracted articles. MetaXL was used for analysis, with all pooled prevalence rates calculated using a random effects model. Heterogeneity among the included studies was assessed using the Chi test and the I statistic.
Fifty-three studies (33,571 right RLNs) reported data on the prevalence of a right NRLN. The pooled prevalence estimate was 0.7% (95% CI [0.6-0.9]). The NRLN was found to originate from the vagus nerve at or above the laryngotracheal junction in 58.3% and below it in 41.7%. A right NRLN was associated with an aberrant subclavian artery in 86.7% of cases.
The NRLN is a rare yet very clinically relevant structure for surgeons and is associated with increased risk of iatrogenic injury, most often leading to temporary or permanent vocal cord paralysis. A thorough understanding of the prevalence, origin, and associated pathologies is vital for preventing injuries and complications.
非返喉返神经（NRLN）是喉返神经（RLN）一种罕见的胚胎发育衍生变异。NRLN的存在显著增加了医源性损伤和手术并发症的风险。我们的目的是对NRLN的总体患病率、其起源及其与异常锁骨下动脉的关联进行全面的荟萃分析。
截至2016年3月，对PubMed、中国知网、ScienceDirect、EMBASE、BIOSIS、SciELO和科学网进行数据库检索。还广泛检索了纳入文章中的参考文献。至少两名审阅者判断文章的合格性并评估和提取文章。使用MetaXL进行分析，所有合并患病率均采用随机效应模型计算。使用卡方检验和I统计量评估纳入研究之间的异质性。
53项研究（33571条右侧RLN）报告了右侧NRLN患病率的数据。合并患病率估计为0.7%（95%CI[0.6 - 0.9]）。发现NRLN起源于喉气管交界处或其上方的迷走神经的占58.3%，起源于其下方的占41.7%。86.7%的病例中右侧NRLN与异常锁骨下动脉有关。
NRLN是一种罕见但对外科医生具有非常重要临床意义的结构，与医源性损伤风险增加相关，最常导致暂时性或永久性声带麻痹。全面了解其患病率、起源和相关病理对于预防损伤和并发症至关重要。
