Moreira Alayne, Forrest Edward, Lee James C, Paul Eldho, Yeung Meei, Grodski Simon, Serpell Jonathan W
Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia.
Department of Surgery, Monash University, Melbourne, Victoria, Australia.
ANZ J Surg. 2020 Sep;90(9):1733-1737. doi: 10.1111/ans.16166. Epub 2020 Aug 11.
There are many clinical associations and potential mechanisms of injury resulting in recurrent laryngeal nerve palsy (RLNP) after thyroidectomy. One possible cause of RLNP is focal intralaryngeal compression of the recurrent laryngeal nerve (RLN), which may be associated with the tracheal tube (TT). Therefore, we examined current RLNP rates to investigate potential associations, including intralaryngeal, airway, anaesthetic and anthropometric factors.
We analysed 1003 patients undergoing thyroid surgery at The Alfred from 2010 to 2017, who had anatomically intact RLNs at the conclusion of thyroidectomy. All included patients underwent pre- and post-operative flexible nasendoscopy. The primary outcome was RLNP rate. We analysed potential associated factors including age, sex, operative time, surgical indication, pathology, American Society of Anaesthesiologists Physical Status, Mallampati scores, body mass index, intubation grade, TT size and specimen weight. The independent risk factors were identified by logistic regression analysis.
Overall, RLNP occurred in 83 patients (8.3%) of which one was permanent (0.1%). On univariate analysis, RLNP was associated with male sex (P = 0.02), and duration of surgery (P = 0.002). On multivariate analysis, both male sex (P = 0.047) and duration of surgery (P = 0.04) remained significant. Further, factors postulated to cause intralaryngeal compression of the RLN, including TT size, body mass index, intubation grade and Mallampati score, were not significantly associated with RLNP.
Our study showed a RLNP rate of 8.3%, and associations with longer operative duration, and male sex. Potential intralaryngeal factors were not identified.
甲状腺切除术后导致喉返神经麻痹（RLNP）的临床关联和潜在损伤机制众多。RLNP的一个可能原因是喉返神经（RLN）的局灶性喉内压迫，这可能与气管导管（TT）有关。因此，我们研究了当前的RLNP发生率，以调查潜在的关联因素，包括喉内、气道、麻醉和人体测量因素。
我们分析了2010年至2017年在阿尔弗雷德医院接受甲状腺手术的1003例患者，这些患者在甲状腺切除术后喉返神经解剖结构完整。所有纳入患者均接受了术前和术后的软性鼻内镜检查。主要结局是RLNP发生率。我们分析了潜在的相关因素，包括年龄、性别、手术时间、手术指征、病理、美国麻醉医师协会身体状况评分、马兰帕蒂评分、体重指数、插管分级、TT尺寸和标本重量。通过逻辑回归分析确定独立危险因素。
总体而言，83例患者（8.3%）发生RLNP，其中1例为永久性（0.1%）。单因素分析显示，RLNP与男性（P = 0.02）和手术时间（P = 0.002）有关。多因素分析显示，男性（P = 0.047）和手术时间（P = 0.04）仍然具有显著性。此外，推测导致RLN喉内压迫的因素，包括TT尺寸、体重指数、插管分级和马兰帕蒂评分，与RLNP无显著关联。
我们的研究显示RLNP发生率为8.3%，与手术时间延长和男性有关。未发现潜在的喉内因素。
