Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, King's College London, London, United Kingdom.
Department of Otorhinolaryngology Head and Neck Surgery, Edinburgh Royal Infirmary, Edinburgh, United Kingdom.
Laryngoscope. 2021 Jun;131(6):1429-1435. doi: 10.1002/lary.29204. Epub 2020 Oct 29.
Recurrent laryngeal nerve (RLN) injury is a recognized risk during thyroid and parathyroid surgery and can result in significant morbidity. The aim of this review paper is to consider the optimal approach to the immediate intraoperative repair of the RLN during thyroid surgery.
A PubMed literature search was performed from inception to June 2020 using the following search strategy: immediate repair or repair recurrent laryngeal nerve, repair or reinnervation recurrent laryngeal nerve and immediate neurorraphy or neurorraphy recurrent laryngeal nerve.
Methods of immediate intraoperative repair of the RLN include direct end-to-end anastomosis, free nerve graft anastomosis, ansa cervicalis to RLN anastomosis, vagus to RLN anastomosis, and primary interposition graft. Techniques of nerve repair include micro-suturing, use of fibrin glue, and nerve grafting. Direct micro-suture is preferable when the defect can be repaired without tension. Fibrin glue has also been proposed for nerve repair but has been criticized for its toxicity, excessive slow reabsorption, and the risk of inflammatory reaction in the peripheral tissues. When the proximal stump of the RLN cannot be used, grafting could be done using transverse cervical nerve, supraclavicular nerve, vagus nerve, or ansa cervicalis.
Current evidence is low-level; however, it suggests that when the RLN has been severed, avulsed, or sacrificed during thyroid surgery it should be repaired intraoperatively. The immediate repair has on balance more advantages than disadvantages and should be considered whenever possible. This should enable the maintenance of vocal cord tone, better and prompter voice recovery and avoidance of aspiration. Laryngoscope, 131:1429-1435, 2021.
喉返神经（RLN）损伤是甲状腺和甲状旁腺手术中公认的风险，可导致严重的发病率。本文的目的是考虑在甲状腺手术中对 RLN 进行即时术中修复的最佳方法。
从 2020 年 6 月开始，通过以下搜索策略在 PubMed 文献中进行了搜索：即时修复或修复 RLN、修复或 RLN 神经再支配以及即时神经吻合或 RLN 神经吻合。
RLN 的即时术中修复方法包括直接端端吻合、游离神经吻合、颈袢神经至 RLN 吻合、迷走神经至 RLN 吻合和原发性间置移植物。神经修复技术包括微缝合、使用纤维蛋白胶和神经移植。当可以在无张力的情况下修复缺损时，直接微缝合是首选。纤维蛋白胶也已被提议用于神经修复，但因其毒性、过度缓慢吸收以及外周组织炎症反应的风险而受到批评。当 RLN 的近端残端不能使用时，可以使用颈横神经、锁骨上神经、迷走神经或颈袢神经进行移植。
目前的证据水平较低；然而，它表明在甲状腺手术中 RLN 被切断、撕脱或牺牲时，应在术中进行修复。即时修复总体上利大于弊，应尽可能考虑。这应该能够维持声带的音调，更好更快地恢复声音，并避免吸入。《喉镜》，131:1429-1435，2021。
