Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, People's Republic of China.
Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, People's Republic of China.
Langenbecks Arch Surg. 2020 Jun;405(4):461-468. doi: 10.1007/s00423-020-01906-y. Epub 2020 Jun 6.
Immediate recurrent laryngeal nerve (RLN) reconstruction at the time of thyroid cancer extirpation can provide excellent postoperative phonatory function. This study is to present our experience with the methods of RLN reconstruction, and to evaluate the role of selective vagus to RLN anastomosis (SVR) in thyroidectomy.
Respective review of RLN reconstruction in thyroid surgery from January 2004 to October 2018 was conducted in two tertiary referral academic medical centers. Immediate RLN reconstruction was performed for primary thyroidectomy patients with intraoperative nerve tumor invasion or iatrogenic transection. Laryngofiberoscopic examination, voice evaluation of maximum phonation time, and GRBAS scale were performed preoperatively, on the second day after surgery, and monthly postoperatively for the first year.
A total of 37 patients were enrolled. Twenty-nine RLNs were resected caused by tumor-associated trauma; the other nerves were inadvertently transected. Direct anastomosis (DA) was performed in eight patients, free nerve graft (FNG) was performed in four patients, ansa cervicalis to RLN anastomosis (ARA) was performed in eight patients, and SVR was performed in 17 patients. The mean periods from the reinnervation surgery of DA, SVR, ARA, and FNG to the phonation recovery were 46 ± 19 (days), 41 ± 29 (days), 83 ± 21 (days), and 137 ± 32 (days), respectively. There were improvements in the GRBAS scale of perceptual voice quality at 1 month for DA and SVR, 2months for ARA.
Intraoperative SVR reinnervation demonstrated voice improvement postoperatively and might be an effective treatment for thyroidectomy-related permanent unilateral vocal cord paralysis.
甲状腺癌切除术时即时重建喉返神经（RLN）可以提供出色的术后发声功能。本研究旨在介绍我们在 RLN 重建方法方面的经验，并评估选择性迷走神经至 RLN 吻合术（SVR）在甲状腺切除术中的作用。
在两家三级转诊学术医疗中心，对 2004 年 1 月至 2018 年 10 月甲状腺手术中 RLN 重建进行了回顾性分析。对于术中神经肿瘤侵犯或医源性切断的原发性甲状腺切除术患者，立即进行 RLN 重建。在术前、术后第 2 天和术后第 1 年每月进行喉纤维镜检查、最大发声时间的语音评估和 GRBAS 量表评估。
共纳入 37 例患者。29 条 RLN 因肿瘤相关创伤而被切除；其他神经被无意中切断。8 例患者行直接吻合术（DA），4 例患者行游离神经移植术（FNG），8 例患者行颈袢至 RLN 吻合术（ARA），17 例患者行 SVR。DA、SVR、ARA 和 FNG 的再神经支配手术后至发声恢复的平均时间分别为 46±19（天）、41±29（天）、83±21（天）和 137±32（天）。DA 和 SVR 在术后 1 个月，ARA 在术后 2 个月的 GRBAS 量表感知音质均有改善。
术中 SVR 神经再支配术后显示出声音改善，可能是甲状腺切除术后永久性单侧声带麻痹的有效治疗方法。
