Miller W, Butters M, Leibl B, Bittner R
Chirurgische Klinik, Marienhospitals Stuttgart.
Chirurg. 1995 Dec;66(12):1210-4.
We analyzed the results of 1147 thyroid operations performed at a teaching hospital over a period of 3 years. These results were submitted to an internal quality control. We studied the factors that influenced the surgical complication rate and particularly the rate of a palsy of the recurrent laryngeal nerve. Operations of 'simple' goitres showed only a very low risk of post-operative complications whereas the risk for patients with Graves' disease, a carcinoma or a recurrent goitre was a markedly higher. The rate of a permanent palsy of the recurrent laryngeal nerve was just 0.5% for a simple goitre but as high as 7.8% for a relapse. Not just the underlying disease but the surgeon and his surgical technique play an important role in the incidence of a palsy of the recurrent laryngeal nerve. If a sophisticated surgical technique is applied without exposing the recurrent laryngeal nerve but leaving the fascial layer that covers the nerve and the vessels of the throat intact, there are no differences between the results of these operations and such where the nerve is routinely demonstrated. The follow-up of the patients with recurrent nerve palsy showed a medium recovery time of half a year. In one of six patients with temporary palsy the restitution was seen after more then one year.
我们分析了一家教学医院在3年时间内进行的1147例甲状腺手术的结果。这些结果接受了内部质量控制。我们研究了影响手术并发症发生率的因素，特别是喉返神经麻痹的发生率。“单纯性”甲状腺肿手术的术后并发症风险极低，而格雷夫斯病、癌或复发性甲状腺肿患者的风险则明显更高。单纯性甲状腺肿的喉返神经永久性麻痹发生率仅为0.5%，但复发时高达7.8%。不仅潜在疾病，外科医生及其手术技术在喉返神经麻痹的发生率中也起着重要作用。如果应用复杂的手术技术而不暴露喉返神经，而是保持覆盖神经和喉部血管的筋膜层完整，这些手术的结果与常规显露神经的手术结果并无差异。对喉返神经麻痹患者的随访显示，平均恢复时间为半年。在六例暂时性麻痹患者中，有一例在一年多后才恢复。
