Ann Ital Chir. 2021;92:217-226.
Identification of recurrent laryngeal nerve (RLN), performed via different techniques, decreases nerve injury during thyroidectomy. We aimed to evaluate the effect of different anatomic levels at which RLN was identified on postoperative complications.
The patients underwent total thyroidectomy or lobectomy without lymph node dissection were included. Two different surgical methods were performed: thyroidectomy identifying RLN at level of inferior thyroid artery (ITA) (Group 1); at level of Berry's ligament (Group 2). Patients were evaluated with indirect laryngoscopy on 3rd postoperative day, if nerve damage was determined, at each six months. Nerve damage and postop hypocalcemia were accepted transient up to 6th month, permanent after 6th month. Total serum calcium levels were postoperatively measured on 24th and 48th hours, and then monthly.
Unilateral and bilateral RLN damage were detected as 4.4% and 2.2% in Group 1; and 8% and 2.67% in Group 2, respectively. The frequency of RLN damage was similar (p=0.62). Postoperative hypocalcemia was significantly higher in Group 1 (p=0.04); hypocalcemia was similar (p=0.149). One patient in Group 1, and 2 patients in Group 2 had f superior laryngeal nerve (SLN) injury. Three patients from each group showed permanent hypocalcemia. One patient in Group 1, and two in Group 2 developed permanent hoarseness.
RLN injury was similar in both groups, however, temporary hypocalcemia was more frequent in patients undergone thyroidectomy with RLN identification at ITA level.
Devascularization of parathyroid glands may be accused. Future studies are needed.
Recurrent laryngeal nerve, Thyroidectomy.
通过不同的技术识别喉返神经（RLN）可降低甲状腺切除术期间的神经损伤。我们旨在评估在 RLN 识别的不同解剖水平上对术后并发症的影响。
纳入接受全甲状腺切除术或无淋巴结清扫的甲状腺叶切除术的患者。进行了两种不同的手术方法：在甲状腺下动脉（ITA）水平识别 RLN 的甲状腺切除术（组 1）；在 Berry 韧带水平识别 RLN 的甲状腺切除术（组 2）。如果确定神经损伤，患者在术后第 3 天进行间接喉镜检查，并在之后每 6 个月进行检查。神经损伤和术后低钙血症在第 6 个月前被认为是暂时的，在第 6 个月后是永久性的。术后第 24 小时和第 48 小时以及之后每月测量总血清钙水平。
组 1中单侧和双侧 RLN 损伤分别为 4.4%和 2.2%；组 2 中分别为 8%和 2.67%。RLN 损伤的频率相似（p=0.62）。组 1 中术后低钙血症明显更高（p=0.04）；低钙血症相似（p=0.149）。组 1 中有 1 例和组 2 中有 2 例患者出现上喉返神经（SLN）损伤。每组中有 3 例患者出现永久性低钙血症。组 1 中有 1 例和组 2 中有 2 例患者出现永久性声音嘶哑。
两组中 RLN 损伤相似，但在 ITA 水平识别 RLN 的甲状腺切除术患者中，暂时性低钙血症更为常见。
甲状旁腺的血供可能受到影响。需要进一步的研究。
喉返神经；甲状腺切除术。
