Johnson P R, Kanegoanker G S, Bates T
William Harvey Hospital, Ashford, Kent, United Kingdom.
J Am Coll Surg. 1994 Jun;178(6):605-8.
Vocal cord function was assessed by indirect laryngoscopy before and after transhiatal esophagectomy for carcinoma of the middle and lower esophagus. Unilateral vocal cord palsy was found in 16 (34 percent) of 47 patients, but three of these patients were not hoarse and coughed normally. Four patients were hoarse postoperatively but had normal vocal cord function on indirect laryngoscopic examination. All vocal cord palsies but one were on the left side and the left side of the neck was used for esophageal mobilization with the only exception of the one patient who had a right cord palsy after a right-sided neck dissection. Patients with impaired vocal cord function did not have a significantly increased stay in the intensive therapy unit or in the hospital, nor was there an increase in pulmonary complications. Vocal cord palsy is a recognized complication of transhiatal esophagectomy, and although it remains unresolved whether or not the recurrent laryngeal nerve damage occurs at the level of the aortic arch or in the neck, the present evidence suggests the latter site. The clinical impression of postoperative vocal cord palsy is often incorrect.
在对中下段食管癌患者行经裂孔食管切除术前后，通过间接喉镜检查评估声带功能。47例患者中有16例（34%）出现单侧声带麻痹，但其中3例患者无声音嘶哑且咳嗽正常。4例患者术后声音嘶哑，但间接喉镜检查时声带功能正常。除1例右侧颈部清扫术后出现右侧声带麻痹的患者外，所有声带麻痹患者（仅1例除外）均为左侧麻痹，且均采用左侧颈部进行食管游离。声带功能受损的患者在重症监护病房或医院的住院时间并未显著延长，肺部并发症也未增加。声带麻痹是经裂孔食管切除术公认的并发症，尽管目前仍未明确喉返神经损伤是发生在主动脉弓水平还是颈部，但现有证据表明是后者。术后声带麻痹的临床判断往往并不准确。
