McCall A R, Ott R, Jarosz H, Lawrence A M, Paloyan E
Am Surg. 1987 Jul;53(7):377-9.
Iatrogenic vocal cord paralysis is a well-publicized complication of thyroid and parathyroid operations. Less appreciated is the improvement of vocal cord function after resection of a thyroid or parathyroid tumor. Over the last 22 years, 14 patients presented with vocal cord paresis in the presence of thyroid or parathyroid tumors. Of these 14 patients, nine had complete resolution of paresis following resection of the thyroid or parathyroid tumors: three had a thyroid carcinoma impinging upon the nerve, three had large colloid goiters, two had a follicular adenoma and one had a parathyroid adenoma displacing the nerve. In five of the 14 patients the vocal cord paralysis persisted after operation. In three, the pathology accounted for the vocal cord paralysis and was not amenable to operative improvement: one patient had an unresectable anaplastic thyroid carcinoma, one patient had long-standing idiopathic unilateral vocal cord paralysis, and one patient had laryngeal adenoid cystic carcinoma with thyroid invasion. The fourth patient had an extensive thyroid hemangioma. The paralysis persisted after resection. The fifth patient had long-standing idiopathic vocal cord palsy. A preoperative vocal cord paresis in a patient with thyroid or parathyroid disease does not indicate permanent loss of recurrent nerve function, even in the presence of carcinoma. In this series, vocal cord function was restored in 9 of 10 patients with resectable thyroid or parathyroid tumors.
医源性声带麻痹是甲状腺和甲状旁腺手术中一种广为人知的并发症。甲状腺或甲状旁腺肿瘤切除术后声带功能的改善却较少受到关注。在过去22年中，14例甲状腺或甲状旁腺肿瘤患者出现声带麻痹。在这14例患者中，9例在甲状腺或甲状旁腺肿瘤切除后麻痹完全缓解：3例为甲状腺癌侵犯神经，3例为巨大胶样甲状腺肿，2例为滤泡性腺瘤，1例为甲状旁腺腺瘤压迫神经。14例患者中有5例术后声带麻痹持续存在。其中3例，病理改变导致声带麻痹，无法通过手术改善：1例患者患有无法切除的间变性甲状腺癌，1例患者患有长期特发性单侧声带麻痹，1例患者患有侵犯甲状腺的喉腺样囊性癌。第4例患者患有广泛的甲状腺血管瘤。切除后麻痹仍持续存在。第5例患者患有长期特发性声带麻痹。甲状腺或甲状旁腺疾病患者术前出现声带麻痹并不意味着喉返神经功能永久丧失，即使存在癌症。在本系列中，10例可切除甲状腺或甲状旁腺肿瘤患者中有9例声带功能得以恢复。
