术前伴喉返神经麻痹的甲状腺肿瘤的临床病理分析  

Clinicopathological analysis of thyroid nodules with preoperative recurrent laryngeal nerve palsy

作　　者：韩春[1] 郑伟慧[1] 王可敬[1] 郭良[1] 

机构地区：[1]浙江省肿瘤医院头颈外科,浙江杭州310022

出　　处：《中国耳鼻咽喉头颈外科》2017年第2期59-62,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：浙江省科技厅公益技术研究社会发展项目(2015C33211);浙江省医药卫生科技计划资助项目(2015KYB065)联合资助

摘　　要：目的探讨术前伴喉返神经麻痹的甲状腺肿瘤的良恶性分布,喉返神经情况及组织病理学特征。方法2007年1月~2014年12月本院共12 488例甲状腺肿瘤患者,其中80例为初治术前伴喉返神经麻痹,分析其临床及病理资料。结果 16例(20.00%)为良性,64例(80.00%)为恶性。良、恶性肿瘤患者性伴喉返神经麻痹率分别为0.30%和0.90%。低-未分化癌患者麻痹率25.93%,显著高于其他病理类型。良性肿瘤患者术中8例未粘连神经,6例粘连,锐性解剖后保留,2例神经变性,无法保留,切除率12.50%。恶性肿瘤患者术中3例神经无粘连,3例包绕,锐性解剖后保留,42例切除,切除率87.50%。低-未分化癌术中神经均切除。经保留神经的14例良性肿瘤患者及6例恶性肿瘤患者术后神经功能获改善或恢复。结论恶性肿瘤患者术前麻痹率显著高于良性肿瘤患者,术中神经切除率高。如能解剖保留神经,术后功能可恢复。OBJECTIVE To investigate the clinical significance of preoperative recurrent laryngeal nerve palsy （RLNP） for thyroid nodules with regard to the incidence of malignancy, recurrent laryngeal nerve involvement and histopathological character. METHODS Eighty patients with preoperative RLNP treated in Zhejiang Cancer Hospital between Jan 2007 to Dec 2014 were enrolled, their clinicopathological data were recorded and retrospectively analyzed. RESULTS Of 80 patients, 16 patients had benign thyroid disease, while the other 64 had malignancies （80.0%）. The preoperative RLNP incidence of benign and malignant lesions was 0.3% and 0.9% respectively. Poorly differentiated and anaplastic thyroid cancer had the higher incidence of preoperative RLNP comparing with other pathology types （25.93%, P〈0.05）. The RLN did not preserved intraoperatively in 2 patients with benign lesions （2/16, 12.5%） and in 42 patients with malignancy lesions （42/48, 87.50%）. All nerves were sacrificed in poorly differentiated and anaplastic thyroid cancer patients. The RLN could be isolated from 14 benign lesions and 6 malignancies, with or without adhesion, and the nerve function was recovered postoperatively. CONCLUSION The probability of preoperative RLNP is significantly higher in malignant lesions than benign lesions. Thyroid tumors with RLNP are strongly suggested of malignancy, with higher rate of intraoperative nerve sacrifice. The RLN should be preserved if it has not been invaded by the tumor, which offers a chance of functional recovery postoperatively.

关 键 词：甲状腺肿瘤 腺癌 乳头状 甲状腺肿 结节性 甲状腺切除术 喉返神经麻痹 

分 类 号：R736.1[医药卫生—肿瘤]