- 期刊
Risk of Vocal Palsy after Thyroidectomy with Identification of the Recurrent Laryngeal Nerve
甲狀腺切除術中找出喉返神經對於術後聲帶麻痺的危險性
摘要
本研究的目的在於評估甲狀腺手術時例行性找出喉返神經對於術後聲帶麻痺的危險性。本研究包含 521 位由同一術者執刀的病人。將病人分為良性甲狀腺疾病、甲狀腺癌、 Graves’病和再次手術四組，並分別計算其暫時性及永久性聲帶麻痺的機率。聲帶麻痺機率的計算是以相關神經的數目為基礎，其中有二十位甲狀腺癌病人、二十六條返喉神經，因疾病關係必須於術中將其截斷者，則不列入計算。共四十位病人於術後有聲帶麻痺的情形，在三十七位於術中可確定返喉神經的完整性的病人，有三十五位（94.6%）其返喉神經之功能完全恢復。暫時性聲帶麻痺恢復的時間從三天至四個月不等，平均 30.7 天。整體而言，暫時性及永久性聲帶麻痺的機率分別為 5.1 % 和 0.9 ％。若將病人分為良性甲狀腺疾病、甲狀腺癌、 Graves’病和再次手術四組，其暫時性及永久性聲帶麻痺的機率分別為 4.0 % 10.2 % , 2.0 % 10.7 % , 12.0 % 11.1 % 和 10.8 % 18.1 %。甲狀腺癌、Graves’病和再次甲狀腺手術的病人有較高的聲帶麻痺的機率，甲狀腺癌的病人有 1 9.4 ％的機率會有腫瘤侵犯返喉神經的情形。於術中可確定返喉神經的完整性的病人，大部分其返喉神經之功能會完全恢復，甲狀腺全葉切除並例行性找出返喉神經應被推薦為甲狀腺的基本手術方法。
並列摘要
The purpose of this study was to assess the risk of vocal palsy after thyroidectomy with identification of recurrent laryngeal nerve (RLN) during surgery. In all, 521 patients treated by the same surgeon were enrolled in this study. Temporary and permanent vocal palsy rates were analyzed for patient groups classified according to surgery for primary benign thyroid disease, thyroid cancer, Graves’ disease, and reoperation. Measurement of the vocal palsy rate was based on the number of nerves at risk. Twenty- six intentionally sacrificed RLNs were excluded from analysis. Forty patients developed postoperative unilateral vocal palsy. Complete recovery of vocal palsy was documented for 35 of the 37 patients (94.6%) whose RLN integrity had been ensured intraoperatively. Recovery from temporary vocal palsy ranged from 3 days to 4 months (mean, 30.7 days). The overall incidences of temporary and permanent vocal palsy were 5.1% and 0.9%, respectively. The rates of temporary/permanent vocal palsy in groups classified according to underlying disease were 4.0%/0.2% for benign thyroid disease, 2.0%/0.7% for thyroid cancer, 12.0% /1.1% for Graves’ disease, and 10.8% /8.1% for reoperation. Surgery for thyroid cancer, Graves’ disease, and recurrent goiter were associated with significantly higher vocal palsy rates. Most patients without documented nerve damage during the operation recovered from postoperative vocal palsy. Total lobectomy with routine RLN identification is recommended as a basic procedure in thyroid surgery.
延伸閱讀
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