Wu Runzhang, Zhang Chaojie, Wang Huiling, Li Meiliang, Lei Shanshan, Zeng Jie, He Jie
Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Hunan Normal University/Hunan Provincial People's Hospital, Changsha, China.
Department of Pathology, The First Affiliated Hospital of Hunan Normal University/Hunan Provincial People's Hospital, Changsha, China.
Gland Surg. 2020 Dec;9(6):2017-2025. doi: 10.21037/gs-20-633.
Complete injury of the recurrent laryngeal nerve (RLN) is a serious complication of thyroid surgery. Increasingly researches focus on the voice recovery of patients with RLN injury. This paper studied the effect of immediate end-to-end neuroanastomosis after complete injury of the unilateral RLN during thyroid surgery on postoperative vocal function.
Thirteen patients who underwent end-to-end neuroanastomosis for the treatment of complete injury of the unilateral RLN caused by thyroid surgery in Hunan Provincial People's Hospital between October 2009 and January 2020 were selected. The basic information, cause of RLN injury, postoperative voice recovery, recovery time, and subjective assessment of voice by auditory perception results (Grade, Roughness, Breathiness, Asthenia, and Strain, the GRBAS score) of the patients were recorded.
Among the 13 cases with RLN injury, the cause of RLN injury in 10 cases was transection by sharp instruments, and the voice was recovered one day after the operation. The cause of RLN injury in one case was suture of the RLN branch, and the voice was recovered one day after the operation. The cause of RLN injury in two cases was thermal injury, and the times for voice recovery after end-to-end neuroanastomosis were 3 and 4 months. The patients with a GRBAS score of 0 or 1 recovered their voice one day after the operation. The GRBAS score reached 1 in the two thermal injury cases, with voice recovery at 3 and 4 months after surgery. By 6 months, the voice recovery rate of the patients was 100%.
After complete injury of the unilateral RLN, immediate end-to-end anastomosis of the RLN can maximally preserve the postoperative vocal function of patients.
喉返神经（RLN）完全损伤是甲状腺手术的严重并发症。越来越多的研究聚焦于RLN损伤患者的嗓音恢复情况。本文研究了甲状腺手术中单侧RLN完全损伤后即刻进行端对端神经吻合术对术后嗓音功能的影响。
选取2009年10月至2020年1月在湖南省人民医院因甲状腺手术导致单侧RLN完全损伤而接受端对端神经吻合术治疗的13例患者。记录患者的基本信息、RLN损伤原因、术后嗓音恢复情况、恢复时间以及通过听觉感知结果进行的嗓音主观评估（等级、粗糙度、气息声、无力感和紧张度，GRBAS评分）。
在13例RLN损伤病例中，10例RLN损伤原因是锐器切断，术后1天嗓音恢复；1例RLN损伤原因是RLN分支缝合，术后1天嗓音恢复；2例RLN损伤原因是热损伤，端对端神经吻合术后嗓音恢复时间分别为3个月和4个月。GRBAS评分为0或1的患者术后1天嗓音恢复。2例热损伤病例GRBAS评分为1，术后3个月和4个月嗓音恢复。至6个月时，患者嗓音恢复率为100%。
单侧RLN完全损伤后，即刻进行RLN端对端吻合可最大程度保留患者术后嗓音功能。
