目的:术后喉返神经麻痹是甲状腺手术并发症之一,瘫痪的预防和管理是外科医生的重要问题。在这项研究中,为了进一步了解甲状腺手术后喉返神经麻痹,我们分析并检查了神经刺激器对喉返神经麻痹的作用以及可能导致喉返神经麻痹的因素。此外,在发生短暂性喉返神经麻痹的情况下,我们分析并检查了每次术中发现和术中手术导致瘫痪的声带运动改善的时机。
方法:在耳鼻咽喉头颈外科,札幌医科大学医院,2012年1月至2021年12月,受试者为543例甲状腺手术患者(692条神经),术前均未发生麻痹或癌神经侵犯。使用单变量和多变量分析评估喉返神经术后短暂性和永久性麻痹之间的关系。评估的因素是性别,年龄,BMI,甲状腺全切除术,仁慈,恶性肿瘤,严重的疾病,使用IIONM(间歇性术中神经监测),使用CIONM(连续术中神经监测),恶性肿瘤T3b或更高,侧颈解剖,和多年的外科医生经验。此外,通过瞄准87条短暂瘫痪的神经,手术分为三组:轻伤、重大伤害,和附着力,并评价其与术后声带运动改善时机的关系。
结果:喉返神经永久性麻痹发生在12条神经(1.7%),100条神经发生一过性麻痹(14.5%)。单因素分析显示与各因素无关联,但多变量分析显示,在男性和使用IIONM的患者中,短暂性麻痹显著降低.轻伤组声带麻痹改善时间为2.8个月,严重损伤组4.5个月,粘连组3.2个月,表明轻微损伤组和严重损伤组之间的统计学差异。
结论:这项研究表明,使用IIONM和对女性进行温和操作可以预防甲状腺手术期间的喉返神经麻痹。此外,了解术后短暂性喉返神经麻痹每次手术的神经恢复时间可能有助于患者解释和确定言语改善手术的治疗干预时机。
OBJECTIVE: Postoperative recurrent laryngeal nerve paralysis is one of the complications of thyroid surgery, and the prevention and management of paralysis is an important issue for surgeons. In this study, in order to gain further understanding of recurrent laryngeal nerve paralysis after thyroid surgery, we analyzed and examined the usefulness of nerve stimulators for recurrent laryngeal nerve paralysis and the factors that may cause recurrent laryngeal nerve paralysis. Furthermore, in cases where transient recurrent laryngeal nerve paralysis occurred, we analyzed and examined the timing of improvement in vocal cord movement for each intraoperative finding and intraoperative operation that caused the paralysis.
METHODS: At the Department of Otorhinolaryngology Head and Neck Surgery, Sapporo Medical University Hospital, between January 2012 and December 2021, the subjects were 543 thyroid surgery cases (692 nerves) without preoperative paralysis or cancer nerve invasion performed. The relationship between postoperative transient and permanent paralysis of the recurrent laryngeal nerve was evaluated using univariate and multivariate analysis. The factors evaluated were gender, age, BMI, total thyroidectomy, benignity, malignancy, Graves\' disease, using IIONM (intermittent intraoperative nerve monitoring), using CIONM (continuous intraoperative nerve monitoring), malignant tumor T3b or higher, with lateral neck dissection, and years of experience of the surgeon. Furthermore, by targeting 87 nerves with transient paralysis, surgical operations were divided into three groups: minor injury, major injury, and adhesion, and their relationship with the timing of postoperative vocal fold movement improvement was evaluated.
RESULTS: Permanent paralysis of the recurrent laryngeal nerve occurred in 12 nerves (1.7 %), and transient paralysis occurred in 100 nerves (14.5 %). Univariate analysis showed no association with each factor, but multivariate analysis showed that transient paralysis was significantly lower in men and in patients using IIONM. The improvement time for vocal cord paralysis was 2.8 months in the minor injury group, 4.5 months in the major injury group, and 3.2 months in the adhesion group, indicating a statistically significant difference between the minor injury group and the major injury group.
CONCLUSIONS: This study suggests that the use of IIONM and gentle manipulation of women may prevent recurrent laryngeal nerve paralysis during thyroid surgery. In addition, understanding the period of nerve recovery for each operation for postoperative transient recurrent laryngeal nerve paralysis may contribute to patient explanations and determining the timing of therapeutic intervention for speech improvement surgery.