Jatzko G R, Lisborg P H, Müller M G, Wette V M
Department of Surgery, Krankenhaus der Barmherzigen Brüder, St. Veit/Glan, Austria.
Surgery. 1994 Feb;115(2):139-44.
Recurrent laryngeal nerve paralysis is one of the most frequent and serious complications after thyroid operation. The routine dissection and demonstration of the recurrent nerve remain controversial. In a retrospective study in an endemic region, patients operated on with principal nerve identification were investigated for vocal paralysis.
Eight hundred and three consecutive goiter operations were analyzed. Because six patients had undergone isthmusectomies only, the recurrent laryngeal nerves were at risk in 797 operations. For 736 patients the surgical procedure was primary for benign disease, for 40 patients the operation was secondary for recurrent goiters, and 21 patients underwent operation for thyroid cancer. All patients underwent preoperative and postoperative laryngoscopic examination of the vocal cords by an ear, nose, and throat specialist.
Rate of primary postoperative vocal cord paralysis was 3.6%, and the permanent palsy rate was 0.5% with a recurrent laryngeal nerve recovery rate of 86%. In a literature survey, reports with identification of the recurrent nerve had significantly lower primary and permanent palsy rates when compared with reports without obligatory identification of the nerve (p < 0.01).
Our results and those of reports in the literature indicate that recurrent nerve paralysis is a less frequent complication when the nerve is identified.
喉返神经麻痹是甲状腺手术后最常见且严重的并发症之一。喉返神经的常规解剖及显露仍存在争议。在某地方性甲状腺肿流行地区进行的一项回顾性研究中，对接受了喉返神经识别手术的患者的声带麻痹情况进行了调查。
分析了连续803例甲状腺肿手术病例。因6例患者仅接受了峡部切除术，故797例手术中喉返神经存在损伤风险。736例患者的手术为原发性良性疾病手术，40例患者为复发性甲状腺肿二次手术，21例患者接受了甲状腺癌手术。所有患者均接受了耳鼻喉专科医生术前及术后的声带喉镜检查。
术后原发性声带麻痹发生率为3.6%，永久性麻痹发生率为0.5%，喉返神经恢复率为86%。在一项文献调查中，与未强制识别喉返神经的报告相比，识别喉返神经的报告中，原发性和永久性麻痹发生率显著更低（p < 0.01）。
我们的研究结果及文献报告表明，识别喉返神经时，喉返神经麻痹是一种较少见的并发症。
