喉返神经减压术  

Recurrent laryngeal nerve decompression

作　　者：徐伟[1] 王海波[1] 曹洪源[1] 樊兆民[1] 岳志勇[1] 吕正华[1] 

机构地区：[1]山东大学山东省立医院耳鼻咽喉头颈外科,济南250021

出　　处：《中华耳鼻咽喉头颈外科杂志》2006年第6期408-411,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨喉返神经减压治疗因甲状腺手术和甲状腺肿物压迫所致喉返神经功能障碍的疗效.方法2002年10月-2005年6月间,行喉返神经减压术治疗单侧喉返神经麻痹9例,声门闭合不全4例.包括甲状腺良性肿物切除术后喉返神经麻痹7例,均为普通外科术后.其中6例神经缝扎,1例神经瘢痕粘连,同时对其中2例行Ⅰ型甲状软骨成形术;甲状腺腺瘤1例和结节性甲状腺肿并喉返神经麻痹1例,均行甲状腺肿物切除喉返神经减压.声门闭合不全的4例中,结节性甲状腺肿3例、桥本甲状腺炎1例分别行甲状腺肿物切除或腺叶部分切除,电子喉镜观察手术前、后声带动度变化,评价手术效果.结果5例神经被结扎和1例神经粘连者于3个月内行减压术,术后1周～3个月声带动度恢复,发声满意;1例神经被结扎于术后4个月行减压术者,随访1年声带动度未见恢复.甲状腺腺瘤和结节性甲状腺肿并喉返神经麻痹患者减压术后3个月内声带动度完全恢复,声门闭合不全并结节性甲状腺肿和桥本甲状腺炎者,术后1周内声门缝隙消失、声嘶消失.结论对于因甲状腺手术所致的喉返神经麻痹,应尽快行喉返神经探查和减压术;声音嘶哑较严重者,可考虑同时行Ⅰ型甲状软骨成形术,以短时间内改善患者发声状况,提高患者生活质量;对于甲状腺肿物合并喉返神经麻痹或声门闭合不良者,应积极行手术探查,行喉返神经减压.Objective To study the result of recurrent laryngeal nerve decompression in the treatment of functional disturbance of recurrent laryngeal nerve caused by thyroid surgery or thyroid benign tumors. Methods From October 2002 to June 2005, 9 cases of unilateral recurrent laryngeal nerve paralysis and 4 cases of glotfic insufficiency were treated with recurrent laryngeal nerve decompression. Seven cases of the nerve paralysis were caused by the surgery of benign thyroid tumors resection which were done by general surgeons. The paralysis nerve were found ligoted in 6 of the 7 cases, and nerve-scar adhesion was found in the other case. Beside nerve decompression, type I thyroplasty have been undertaken in the same time to 2 of the 7 cases with severe hoarseness. One case of thyroid adenoma and 1 case of nodular goiter with unilateral recurrent laryngeal nerve paralysis were treated with tumor resection and nerve decompression respectively. Four cases of glotfic insufficiency, 3 cases of nodular goiter were treated with tumor resection and nerve decompression, and Hashimoto＇s thyroiditis in the other case was treated with partial lobe resection and nerve decompression. The recovery of function of recurrent laryngeal nerve were detected to the recovery of vocal cord mobility through electrolaryngnscope postopertively. Results For the 7 cases of recurrent laryngeal nerve paralysis after thyroid surgery, the motion of the paralysed vocal cord restored within 3 months in 6 cases with the interval of 1 week to 3 months between the two operations, no restoration was found in the other patient with an interval above 4 months between the two operations after 1 year follow-up. For the thyroid adenoma and nodular goiter with unilateral recurrent laryngeal nerve paralysis, the motion of paralysed vocal cord restored within 3 months respectively after decompression. The glotfic closure recovered within 1 week after decompression in the 4 cases of the glottic insufficiency patient. Conclusions Exploration and decompression as soon

关 键 词：喉返神经 甲状腺疾病 声带麻痹 减压术 外科 

分 类 号：R653[医药卫生—外科学]