Joosten U, Brune E, Kersting J U, Hohlbach G
Chirurgische Universitätsklinik der Ruhr-Universität Bochum, Marienhospital Herne.
Zentralbl Chir. 1997;122(4):236-45.
risk factors of recurrent laryngeal nerve (RLN) palsy after thyroid gland surgery were evaluated retrospectively in 1556 patients who were submitted to an operation because of a benign thyroid disease. Recurrences were also excluded.
RLN palsy occurred in 6.6%. In relation to the nerves at risk the incidence of primary postoperative nerve damages was 4.3%. After a long-term follow-up of in total 18 months the incidence of permanent nerve palsy was 1.6% (related to the nerves at risk: 1.1%) as 75.5% of the paralyses were transient in an average of 6.2 months. Substernal goitres especially when sternotomy became necessary, the ligature of the inferior laryngeal artery, serious perioperative complications and total lobectomy in comparison to subtotal resection were important risk factors for primary postoperative RLN palsy (p < 0.05 resp. p < 0.01). The ligature of the inferior laryngeal artery and the extension of resection were indeed significant risk factors also for permanent nerve damages, but the other factors had no influence on the risk of permanent RLN palsy. However, the non-exposure of RLN in subtotal lobectomy was significantly associated (p < 0.01) with permanent, but not with transient nerve palsy.
The exposure of the RLN is one of the most important procedures during thyroid surgery and particular also during subtotal lobectomy to reduce the rate of permanent RLN damages.
对1556例因良性甲状腺疾病接受手术的患者进行回顾性评估，以确定甲状腺手术后喉返神经（RLN）麻痹的危险因素。复发情况也被排除在外。
RLN麻痹发生率为6.6%。就有风险的神经而言，术后原发性神经损伤发生率为4.3%。经过总共18个月的长期随访，永久性神经麻痹发生率为1.6%（与有风险的神经相关：1.1%），因为75.5%的麻痹是暂时性的，平均持续6.2个月。胸骨后甲状腺肿，尤其是在需要进行胸骨切开术时，喉下动脉结扎，严重的围手术期并发症以及与次全切除相比的全叶切除术是术后原发性RLN麻痹的重要危险因素（分别为p < 0.05和p < 0.01）。喉下动脉结扎和切除范围确实也是永久性神经损伤的重要危险因素，但其他因素对永久性RLN麻痹风险没有影响。然而，在次全叶切除术中未暴露RLN与永久性而非暂时性神经麻痹显著相关（p < 0.01）。
RLN的暴露是甲状腺手术尤其是次全叶切除术中最重要的操作之一，以降低永久性RLN损伤的发生率。
