中国实用外科杂志

中国实用外科杂志 ›› 2012, Vol. 32 ›› Issue (05): 364-367.

• 专题笔谈 • 上一篇    下一篇

甲状腺手术单侧喉返神经损伤手术探查与修复

李    孟，郑宏良   

  1. 第二军医大学长海医院耳鼻咽喉头颈外科，上海200433
  • 出版日期:2012-05-01 发布日期:2012-04-26

  • Online:2012-05-01 Published:2012-04-26

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摘要：

喉返神经损伤引起的声带麻痹是甲状腺手术常见的严重并发症之一，以单侧多见，造成不同程度的声音嘶哑、误吸和呛咳等症状，影响病人的生活质量。传统的治疗方法如声带注射术、甲状软骨成形术和杓状软骨内收术等虽能改善发音，但这种声音缺乏音调、音量的调节功能，且远期疗效不满意。声带麻痹的最佳治疗方法是通过神经修复手术恢复麻痹喉的生理性功能。手术方法包括：喉返神经探查减压术、喉返神经端端吻合术、颈袢喉返神经吻合术、游离神经移植术、神经肌蒂埋植术或神经植入术、舌下神经转位术及喉神经修复联合声带内移术等。早期减压效果最佳，颈袢喉返神经吻合等神经修复术也能有效地恢复喉的发音功能。损伤病程长者宜采用神经修复联合声带内移手术。喉神经修复术式的选择应根据病程、神经损伤的部位、程度、类型而定。

关键词: 喉返神经损伤, 声带麻痹, 神经探查, 神经修复

Abstract:

Exploration and reinnervation of recurrent laryngeal nerve injury in thyroid surgery        LI Meng, ZHENG Hong-liang. Department of Otolaryngology Head & Neck Surgery, the Second Military Medical University, Shanghai 200433, China
Corresponding author：ZHENG Hong-liang，E-mail：zheng_hl2004@163.com
Abstract    As one of the most common and serious complications of thyroid surgery, unilateral vocal cord paralysis caused by recurrent laryngeal nerve (RLN) injury can lead to varying degrees of hoarseness, aspiration, and coughing, which affects quality of life of patients. Traditional treatment methods including vocal fold injection, thyroplasty can improve vocal function. However, the voice is lack of regulatory function of tone and volume, and long-term efficacy is not satisfactory. The best treatment for vocal cord paralysis is reinnervation of the RLN so as to recover the physiological function of the paralyzed larynx, which consists of nerve exploration and decompression, end to end anastomosis of RLN, ansa cervicalis to RLN anastomosis, free nerve graft transfer, nerve muscular pedicle, nerve implantation and reinnervation surgery combined with medialization of vocal cord. For thyoid surgery-related UVFP patients, early nerve decompression has the best effect, and ansa cervicalis to RLN anastomosis can also be effective in restoring the pronunciation function of the larynx. And for those who had long denervation course, reinnervation surgery combined with mediliazation should be performed. Selection of the laryngeal reinnervation protocols should depend on the course, severity and type of nerve injury.

Key words: recurrent laryngeal nerve injury, vocal fold paralysis, nerve exploration；reinnervation surgery