1273例甲状腺癌中央区淋巴结清扫术中喉返神经损伤情况

Laryngeal nerve morbidity in 1.273 central node dissections for thyroid cancer.

作者信息

Liu Xiaoli, Zhang Daqi, Zhang Guang, Zhao Lina, Zhou Le, Fu Yantao, Li Shijie, Zhao Yishen, Li Changlin, Wu Che-Wei, Chiang Feng-Yu, Dionigi Gianlorenzo, Sun Hui

机构信息

Jilin Provincial Key Laboratory of Surgical Translational Medicine, China-Japan Union Hospital of Jilin University, Division of Thyroid Surgery, Changchun City, Jilin Province, China.

Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.

出版信息

Surg Oncol. 2018 Jun;27(2):A21-A25. doi: 10.1016/j.suronc.2018.01.003. Epub 2018 Jan 31.

DOI:10.1016/j.suronc.2018.01.003

PMID:29525322

Abstract

AIM

We assess the prevalence and mechanism of recurrent laryngeal nerve (RLN) injury in central neck dissection (CND) for thyroid cancer.

METHODS

CND with intraoperative neural monitoring was outlined in 1.273 nerves at risk (NAR). RLN lesions were stratified according to: timing (during thyroidectomy versus CND), segmental vs. diffuse injury, mechanism, severity, location, number of lymph nodes dissected and metastastatic. EMG parameters were recorded.

RESULTS

49/1.273NAR (3,8%) documented RLN palsy. 25 nerves were injured during thyroidectomy, 8 while CND. In 16 no precise moment or mechanism of injury was identified. A disrupted point could be identified in 19/25 (76%) and 7/8 (87%) respectively for thyroidectomy and CND steps. Diffuse injury, occurred in 24% and 12,5% respectively for thyroidectomy and CND. Nerves were injured in the all cervical nerve course without any major location for incidence for CND; for thyroidectomy most nerves were injured in the last 1 cm course. Traction (36%) was the leading cause of RLN injury for thyroidectomy. For solely CND, traction, entrapment and thermal injuries were equally frequent. Permanent vs. transient injuries were respectively 8% (4/49) and 92% (n.45/49), overall. Permanent lesions were equally distributed.

CONCLUSIONS

During CND, RLN palsy still occurs with routine exposure of the nerve even combined with IONM. The incidence of nerve lesions during thyroidectomy is higher than that of CND.

摘要

目的

我们评估甲状腺癌中央区颈清扫术（CND）中喉返神经（RLN）损伤的发生率及机制。

方法

对1273条有风险的神经（NAR）进行术中神经监测下的CND。根据以下因素对RLN损伤进行分层：时间（甲状腺切除术期间与CND期间）、节段性与弥漫性损伤、机制、严重程度、位置、清扫淋巴结数量及转移情况。记录肌电图参数。

结果

1273条NAR中有49条（3.8%）记录有RLN麻痹。25条神经在甲状腺切除术期间受损，8条在CND期间受损。16条神经未发现确切的损伤时刻或机制。在甲状腺切除术和CND步骤中，分别有19/25（76%）和7/8（87%）能确定损伤点。弥漫性损伤在甲状腺切除术和CND中分别占24%和12.5%。在整个颈段神经行程中均有神经受损情况，CND无明显高发位置；甲状腺切除术中多数神经在最后1厘米行程中受损。牵拉（36%）是甲状腺切除术导致RLN损伤的主要原因。仅就CND而言，牵拉、卡压和热损伤发生率相当。总体而言，永久性损伤与暂时性损伤分别为8%（4/49）和92%（45/49）。永久性损伤分布均匀。