Pandey Apoorva Kumar, Varma Arvind, Bansal Chetan, Bhardwaj Aparna
Department of ENT, Shri Guru Ram Rai Institute of Medical Sciences, Dehradun, Uttarakhand 248001 India.
Department of ENT, ONGC Hospital, 8979467716 Dehradun, India.
Indian J Otolaryngol Head Neck Surg. 2023 Sep;75(3):1363-1369. doi: 10.1007/s12070-023-03541-7. Epub 2023 Feb 14.
Identifying and preserving the recurrent laryngeal nerve (RLN) is of paramount importance during thyroid surgeries. Iatrogenic injuries to RLN (RLNI) are considered one of the most serious and feared complications of thyroidectomies. Surgically, there are four routes/approaches (lateral, inferior, superior, and medial) for localizing and identifying the RLN. This study aims to estimate the incidence of RLNI in the context of various approaches taken intra-operatively for nerve localization and identification.
This retrospective analytical study included 54 cases of thyroidectomies operated for various benign and malignant thyroid disorders in a tertiary care center from January 2018 to December 2020. Intraoperative search, identification, and dissection of the nerve were done with superior, inferior, medial, and lateral approaches. The chi-square test and exact test were used to analyze the data and p-value < 0.05 was considered significant. Pre- and post-operative recurrent laryngeal nerve evaluation was done with 90 degrees Hopkins laryngoscope.
Overall in this series, the incidence of post-thyroidectomy RLNI was 3.7% and 3.7% for permanent and temporary nerve insults, respectively. Non-recurrent RLN on the right side was identified in one case and extra-laryngeal branching of RLN was identified in two cases. There was no statistically significant difference (p = 0.929) between the different approaches taken and the incidence of RLNI. The type of surgery and pathology also expressed no statistically significant relevance with the incidence of RLNI (p = 0.463 and p = 0.277, respectively).
Adoption of a particular surgical approach to localize and identify RLN during thyroid surgery carries no statistically significant difference between RLNI and approaches taken. Meticulous handling and dissection of the tissue in the correct surgical plane are crucial determinants in preventing RLNIs.
在甲状腺手术中识别并保留喉返神经（RLN）至关重要。喉返神经医源性损伤（RLNI）被认为是甲状腺切除术最严重且令人担忧的并发症之一。在手术中，有四种定位和识别喉返神经的路径/方法（外侧、下方、上方和内侧）。本研究旨在评估在术中采用各种神经定位和识别方法的情况下喉返神经医源性损伤的发生率。
这项回顾性分析研究纳入了2018年1月至2020年12月在一家三级医疗中心因各种良性和恶性甲状腺疾病接受甲状腺切除术的54例患者。采用上方、下方、内侧和外侧方法进行术中神经搜索、识别和解剖。使用卡方检验和精确检验分析数据，p值<0.05被认为具有统计学意义。术前和术后使用90度Hopkins喉镜对喉返神经进行评估。
在本系列研究中，总体而言，甲状腺切除术后永久性和暂时性神经损伤导致的喉返神经医源性损伤发生率分别为3.7%和3.7%。右侧发现1例非喉返神经，2例发现喉返神经的喉外分支。所采用的不同方法与喉返神经医源性损伤的发生率之间无统计学显著差异（p = 0.929）。手术类型和病理与喉返神经医源性损伤的发生率也无统计学显著相关性（分别为p = 0.463和p = 0.277）。
在甲状腺手术中采用特定的手术方法定位和识别喉返神经，在喉返神经医源性损伤与所采用的方法之间无统计学显著差异。在正确的手术平面细致处理和解剖组织是预防喉返神经医源性损伤的关键决定因素。
