Department of General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China.
Int J Surg. 2020 Nov;83:125-130. doi: 10.1016/j.ijsu.2020.08.058. Epub 2020 Sep 12.
The use of intraoperative neuromonitoring (IONM) for visual identification of recurrent laryngeal nerve (RLN) has decreased the rates of RLN injury (RLNI) during thyroid surgery. However, little attention has been paid to RLNI near the nerve entry point (NEP), where most injuries occur. The aim of this study was to determine the mechanism of RLNI near the NEP and to describe the recovery of nerve function.
Patients undergoing thyroid surgery were analyzed to identify true loss of signal (LOS) by IONM. Follow-up for vocal cord palsy (VCP) was confirmed by a postoperative laryngoscopy. The risk factors for RLNI, the type of RLNI, the prevalence of VCP and the time for VCP recovery were all recorded and analyzed.
We analyzed 3582 at-risk nerves in 2257 surgical patients. The overall rate of RLNI near the NEP in at-risk nerves was 3.2%. RLNI was more likely to occur in nerves with extralaryngeal bifurcation (p = 0.013). The distribution of RLNI types, in order of frequency, was traction (52.6%; n = 61), compression (38.8%; n = 45), thermal (7.8%; n = 9), and nerve transection (0.9%; n = 1). Complete recovery from VCP was documented in 93.1% (n = 108) of RLNI.
Patients with a bifurcated RLN were at a higher risk of RLNI near the NEP than those without bifurcation. Traction and compression injuries occurred most frequently, but would eventually recover. Excessive stretching of the thyroid lobe played a role in RLNIs near the NEP.
术中神经监测（IONM）用于可视化识别喉返神经（RLN），降低了甲状腺手术中 RLN 损伤（RLNI）的发生率。然而，对于 RLN 在神经入口点（NEP）附近的损伤，人们关注甚少，而大多数损伤发生在此处。本研究旨在确定 NEP 附近 RLNI 的发生机制，并描述神经功能的恢复情况。
对接受甲状腺手术的患者进行分析，以确定 IONM 中的真实信号丢失（LOS）。通过术后喉镜检查确认声带麻痹（VCP）的随访情况。记录并分析 RLNI 的危险因素、RLNI 的类型、VCP 的发生率以及 VCP 恢复时间。
我们分析了 2257 例手术患者的 3582 条高危神经。高危神经 NEP 附近 RLNI 的总体发生率为 3.2%。NEP 附近 RLNI 更易发生于具有喉外分叉的神经（p=0.013）。RLNI 类型的分布频率依次为牵拉（52.6%；n=61）、压迫（38.8%；n=45）、热损伤（7.8%；n=9）和神经横断（0.9%；n=1）。VCP 完全恢复的记录见于 93.1%（n=108）的 RLNI 患者。
与无分叉的 RLN 相比，RLN 分叉的患者 NEP 附近 RLNI 的风险更高。牵拉和压迫性损伤最常见，但最终会恢复。甲状腺叶过度牵拉在 NEP 附近的 RLNIs 中起作用。
