Spinelli C, Berti P, Miccoli P
Instituto di Clinica Chirurgica, Università degli Studi di Pisa.
Minerva Chir. 1995 Jan-Feb;50(1-2):93-6.
The authors report an experience of 1800 surgical operations for thyroid diseases executed, with identification of the recurrent laryngeal nerve in all cases, from 1988 to 1992, and analyse the various causes of recurrent laryngeal nerve injury. This complication of thyroid surgery is not completely avoidable, in spite of an extremely accurate surgical technique. In most instances of injury to one of the recurrent laryngeal nerves during thyroidectomy, the surgeon can confirm that the recurrent laryngeal nerve was not sectioned during the operation. This fact demonstrates that often the recurrent laryngeal nerve injury is due not to a section but to a stretching, a compression, an ischemia of the nerve. The recurrent laryngeal nerve injury may be due to a mistake in surgical technique: the ligation of the inferior pole vessels before identifying the recurrent laryngeal nerve; a mistake in hemostasis maneuvers; excessive aspiration near to the nerve; an excessive traction of the recurrent laryngeal nerve during the medial traction of the thyroid lobe with a stretching of the nerve; an excessive dissection of the nerve with ischemia. Other causes that make easier the recurrent laryngeal nerve injury are, anatomic variations of the nerve; extension of the surgical operation; histologic findings.
作者报告了1988年至1992年期间进行的1800例甲状腺疾病外科手术的经验，所有病例均对喉返神经进行了识别，并分析了喉返神经损伤的各种原因。尽管手术技术极为精确，但甲状腺手术的这种并发症仍无法完全避免。在大多数甲状腺切除术中喉返神经损伤的病例中，外科医生可以确认手术过程中喉返神经未被切断。这一事实表明，喉返神经损伤往往不是由于切断，而是由于神经的牵拉、压迫或缺血。喉返神经损伤可能是由于手术技术失误：在识别喉返神经之前结扎下极血管；止血操作失误；在神经附近过度吸引；在甲状腺叶向内侧牵拉时过度牵拉喉返神经导致神经拉伸；对神经过度解剖导致缺血。其他使喉返神经更容易损伤的原因包括神经的解剖变异、手术范围扩大和组织学发现。
