喉返神经损伤的临床特点及其防治  

Clinical Characteristics and Prevention of Recurrent Laryngeal Nerve Injury in Thyroid Surgery

作　　者：姜燕[1] 高博[1] 张姝[1] 郭翎佶 田武国 徐琰[1] 张晓华[1] 严洁[1] 罗东林[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所乳腺甲状腺血管外科,重庆400042

出　　处：《中国伤残医学》2016年第9期12-15,共4页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的：探讨甲状腺手术喉返神经损伤的临床特点及其防治。方法：回顾性分析2010年1月～2014年12月在我科行手术治疗的1328例甲状腺患者的临床资料，探讨喉返神经损伤的临床特点及术中、术后处理方法。结果：48例发生损伤，损伤率3．61％，其中44例发生单侧喉返神经损伤，4例患者发生双侧喉返神经损伤，暂时性损伤45例，永久性损伤3例，损伤率0．23％。8例术中行喉返神经吻合术，术后发生声音嘶哑，7例3～6个月声音恢复，1例术后10个月恢复。2例行喉返神经探查减压术，拆除缝线，术后2～6个月声带运动恢复。2例双侧喉返神经损伤，双侧声带固定，活动差，其中1例行气管切开及CO2激光杓状软骨切除术，半年后呼吸困难明显好转，成功拔除气管导管，顺利恢复，但仍有声音低沉，沙哑。1例出现呼吸困难，短暂性声音沙哑，半年后声音恢复正常，偶有痰鸣及夜间阵发性呼吸困难。结论：术中应掌握喉返神经解剖及变异，常规暴露喉返神经，能有效预防损伤。喉返神经损伤早期干预治疗以早发现、早探查、早吻合为主。后期治疗以改善声音、扩大声门，改善呼吸困难为主。Objective ： To investigate the clinical characteristics and prevention of recurrent laryngeal nerve （ RLN ） injury in thyroid surgery. Methods： Clinical features of 1328 patients who received thyroid surgery from January 2010 to December 2014 were analyzed ret- rospectively, and the features of RLN injury and intraoperative as well as postoperative treatments were discussed. Results： RLN injury occurred in 48 patients （ 3.61% ） , in which, unilateral RLN injury occurred in 44 patients and bilateral RLN injury occurred in 4 patients （ temporary injury in 45 patients and permanent injury in 3 patients ,accounting for 0.23% ）. 8 patients underwent RLN anastomosis during surgery and exhibited transient hoarseness after surgery, in which, 7 patients recovered after 3 - 6 months and 1 patient recovered after 10 months. RLN exploration and decompression was given in 2 patients, who got normal vocal cord motion 2 months after stitches removal. 2 patients suffered bilateral RLN injury, bilateral fixed cord and poor activity, in which, 1 patient received trachcotomy and CO2 laser re- section of arytenoid cartilage, dyspnea improved markedly after six months, tracheal catheter removed successfully, who recovered and still exhibited deep and hoarse voice. Dyspnea and transient hoarse voice occured in other patient, after six months, sound got back to normal and occasional phlegm and nocturnal paroxysmal dyspnea happened. Conclusion： In order to prevent RLN injury, the anatomic variations of RLN should be mastered, meanwhile, routine exposure of RLN can effectively prevent this injury. Early interventions for RLN injury in- clude mainly early discovery, early exploration and early anastomosis. The subsequent treatments mainly focus on the improvement of the voice, expansion of glottis and melioration of dyspnea.

关 键 词：喉返神经损伤 临床特点 预防 治疗 

分 类 号：R581[医药卫生—内分泌]