Acıbadem Maslak Hospital, Department of Otorhinolaryngology, Istanbul, Turkey.
Haseki Training and Research Hospital, Department of Otorhinolaryngology, Istanbul, Turkey.
Clin Ther. 2018 May;40(5):762-767. doi: 10.1016/j.clinthera.2018.04.004.
Our aim was to compare the effects of exposing the recurrent laryngeal nerve throughout its entire course with exposing the nerve only at its entry to the larynx in patients undergoing total thyroidectomy due to benign thyroid diseases, and to evaluate the effects of these methods on the risk for hypoparathyroidism.
The medical records of 437 patients who had undergone total thyroidectomy at the ear, nose, and throat clinic between 2001 and 2015 for benign thyroid diseases were evaluated retrospectively. Mean patient age was 46.7 years (range 18-79 years). Eighty-six patients were male and 351 were female. Patients were divided into 2 groups according to recurrent laryngeal nerve exposure during surgery. In the first group, the nerve was observed as it entered the larynx, and its course was not completely exposed. In the second group, the nerve was identified in the tracheoesophageal groove, and its course was fully exposed. Group 1 consisted of 256 patients (47 male and 209 female) and group 2 consisted of 181 patients (39 male and 142 female). There were no statistically significant differences between the groups in terms of age and gender, and the groups were homogeneously distributed.
Transient hypoparathyroidism was observed in 15 (5.8%) patients and permanent hypoparathyroidism was observed in 3 (1.1%) patients in group 1, and transient hypoparathyroidism was observed in 23 (12.7%) patients and permanent hypoparathyroidism was observed in 7 (3.8%) patients in group 2. The rates of both transient and permanent hypoparathyroidism were higher in the patients in group 2, and the difference was statistically significant (P < 0.001). Transient recurrent nerve palsy was seen in 1 patient in each group. Permanent recurrent nerve palsy occurred in 1 patient in group 2, although the difference between groups was not statistically significant (P = 0.28).
Transient and permanent hypoparathyroidism were less common in thyroidectomies that involved detection of the recurrent laryngeal nerve at the site of entry to the larynx and keeping its dissection minimal; this technique was also more reliable.
我们旨在比较在因良性甲状腺疾病而接受甲状腺全切除术的患者中，全程暴露喉返神经与仅在神经进入喉部时暴露神经的效果，并评估这些方法对甲状旁腺功能减退症风险的影响。
回顾性分析了 2001 年至 2015 年间在耳鼻喉科诊所因良性甲状腺疾病接受甲状腺全切除术的 437 例患者的病历。患者平均年龄为 46.7 岁（18-79 岁）。86 例为男性，351 例为女性。根据手术中喉返神经暴露情况，患者被分为 2 组。在第一组中，观察神经进入喉部时的情况，并不完全暴露其走行。在第二组中，在气管食管沟中识别神经，并充分显露其走行。第 1 组包括 256 例患者（47 例男性，209 例女性），第 2 组包括 181 例患者（39 例男性，142 例女性）。两组在年龄和性别方面无统计学差异，且组间分布均匀。
第 1 组中 15 例（5.8%）患者出现暂时性甲状旁腺功能减退症，3 例（1.1%）患者出现永久性甲状旁腺功能减退症，第 2 组中 23 例（12.7%）患者出现暂时性甲状旁腺功能减退症，7 例（3.8%）患者出现永久性甲状旁腺功能减退症。第 2 组患者中暂时性和永久性甲状旁腺功能减退症的发生率均较高，差异具有统计学意义（P < 0.001）。第 1 组中各有 1 例患者出现暂时性喉返神经麻痹，第 2 组中 1 例患者出现永久性喉返神经麻痹，但两组间差异无统计学意义（P = 0.28）。
在甲状腺切除术时，在神经进入喉部的部位检测喉返神经并尽量减少其解剖，甲状旁腺功能减退症的发生率更低，永久性甲状旁腺功能减退症的发生率更低，该技术更可靠。
