Kark A E, Kissin M W, Auerbach R, Meikle M
Br Med J (Clin Res Ed). 1984 Nov 24;289(6456):1412-5. doi: 10.1136/bmj.289.6456.1412.
Hitherto voice changes have been regarded as an infrequent complication of thyroidectomy and damage to the recurrent laryngeal nerve has been given as their major cause. Voice function was assessed in 325 patients after thyroidectomy. Permanent changes occurred in 35 (25%) after subtotal thyroidectomy and in 19 (11%) after lobectomy. The commonest cause of voice change appeared to be injury to the external laryngeal nerves on one or both sides. Damage to the recurrent laryngeal nerve, which was routinely identified and protected, was rarely a cause. When the external laryngeal nerves were identified and preserved, permanent voice changes occurred in only 5% of cases; this was similar to the incidence of 3% in controls after endotracheal intubation alone. The course of the external laryngeal nerve is variable, and consequently mass ligation of the vessels at the top of the upper pole will damage it in a high proportion of cases. To minimise this serious complication these nerves should be identified and protected as well as the recurrent nerves and voice function should be assessed early in the postoperative period by laryngoscopy and by a speech therapist.
迄今为止，嗓音变化一直被视为甲状腺切除术的一种罕见并发症，其主要原因被认为是喉返神经损伤。对325例甲状腺切除术后患者的嗓音功能进行了评估。甲状腺次全切除术后35例（25%）出现永久性嗓音变化，甲状腺叶切除术后19例（11%）出现永久性嗓音变化。嗓音变化最常见的原因似乎是一侧或双侧喉外神经损伤。而常规识别并加以保护的喉返神经损伤很少是嗓音变化的原因。当识别并保留喉外神经时，永久性嗓音变化仅发生在5%的病例中；这与仅行气管插管的对照组3%的发生率相似。喉外神经的走行多变，因此在上极顶部进行血管大块结扎时，在很大比例的病例中会损伤该神经。为了将这种严重并发症降至最低，这些神经以及喉返神经均应予以识别和保护，并且应在术后早期通过喉镜检查和言语治疗师对嗓音功能进行评估。
