Liu Nan, Chen Bo, Li Luchuan, Zeng Qingdong, Sheng Lei, Zhang Bin, Liang Weili, Lv Bin
Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China.
Cancer Manag Res. 2021 Dec 1;13:8979-8987. doi: 10.2147/CMAR.S338551. eCollection 2021.
Recurrent laryngeal nerve injury (RLNI) still occurs in total endoscopic thyroidectomy (TET) by using intraoperative neuromonitoring (IONM). As the region where most injuries occur, more attention should be paid to RLNI near the nerve entry point (NEP) in TET.
This cohort study collected retrospectively data from 415 patients who underwent TET between February 2012 and December 2019. The functions of the recurrent laryngeal nerve (RLN) in TET were recorded by IONM. The patients with RLNI near the NEP were followed up by laryngoscopies. The demographic and clinical characteristics, the mechanisms of RLNI, and the outcomes of RLNI were recorded and analyzed.
There were a total of 444 at-risk nerves in 405 patients were analyzed. The incidence of RLNI near the NEP was 7.9%. RLNs with extralaryngeal branches were more likely to be injured near the NEP (P = 0.037). The incidences of different types of RLNI, in order of frequency, were 68.8% for thermal injury (n = 22), 28.1% for traction/compression injury (n = 9), and 3.1% for transverse injury (n = 1). A total of 93.8% (n = 30) of RLNI patients had complete recovery of vocal cord activity function.
The extralaryngeal branch was a risk factor for RLNI near the NEP in TET. Thermal injury caused by an ultrasonic scalpel was the most common cause of RLNI near the NEP. Most RLNIs near the NEP would eventually recover.
在全内镜甲状腺切除术（TET）中，即便使用术中神经监测（IONM），喉返神经损伤（RLNI）仍有发生。作为损伤最常出现的区域，TET中靠近神经入点（NEP）的RLNI应得到更多关注。
这项队列研究回顾性收集了2012年2月至2019年12月期间接受TET的415例患者的数据。通过IONM记录TET中喉返神经（RLN）的功能。对NEP附近发生RLNI的患者进行喉镜随访。记录并分析患者的人口统计学和临床特征、RLNI的机制以及RLNI的结局。
共分析了405例患者的444条有风险的神经。NEP附近RLNI的发生率为7.9%。有喉外分支的RLN在NEP附近更易受损（P = 0.037）。不同类型RLNI的发生率，按频率排序，热损伤为68.8%（n = 22），牵拉/压迫损伤为28.1%（n = 9），横断损伤为3.1%（n = 1）。共有93.8%（n = 30）的RLNI患者声带活动功能完全恢复。
喉外分支是TET中NEP附近RLNI的一个危险因素。超声刀造成的热损伤是NEP附近RLNI最常见的原因。大多数NEP附近的RLNI最终会恢复。
