目的:喉返神经(RLN)的解剖变异在甲状腺切除术中很常见。我们的目的是评估RLN瘫痪在其解剖变异的情况下的风险,回顾性。
方法:纳入2016年1月至2019年12月进行原发性甲状腺切除术的患者。年龄的影响,性别,手术干预,神经监测类型,中央颈淋巴结清扫术,术后诊断,颈部一侧,咽外分支,非RLN,RLN与甲状腺下动脉(ITA)的关系,研究了Zuckerkandl结节在声带麻痹(VCP)上的分级。
结果:这项研究纳入了1070个颈部。喉外分支率为35.5%。45.9%的RLN位于ITA的前部,44.5%位于ITA的后部,9.6%的人在ITA的分支机构之间交叉。总VCP率为4.8%(瞬时:4.5%,永久性:0.3%)。与非分支神经相比,喉外分支神经的总VCP和短暂性VCP的发生率明显更高(6.8%vs.3.6%,p=0.018;6.8%vs.3.2%,分别为p=0.006)。总VCP率为7.2%,2.5%,在RLN交叉的情况下,为2.9%,ITA的后部和分支之间,分别(p=0.003)。关于瞬时VCP率的差异也是显著的(p=0.004)。前交叉模式使总VCP率和瞬时VCP率增加了2.8和2.9倍,分别。
结论:RLN向前穿越ITA和RLN分支是常见的解剖学变异,增加了甲状腺切除术中VCP的风险,术前无法预测。本研究首次报道RLN和ITA之间的关系增加了VCP的风险。
OBJECTIVE: The anatomical variations of the recurrent laryngeal nerve (RLN) are common during thyroidectomy. We aimed to evaluate the risk of RLN paralysis in case of its anatomical variations, retrospectively.
METHODS: The patients with primary thyroidectomy between January 2016 and December 2019 were enrolled. The effect of age, gender, surgical intervention, neuromonitorisation type, central neck dissection, postoperative diagnosis, neck side, extralaryngeal branching, non-RLN, relation of RLN to inferior thyroid artery (ITA), grade of Zuckerkandl tubercle on vocal cord paralysis (VCP) were investigated.
RESULTS: This study enrolled 1070 neck sides. The extralaryngeal branching rate was 35.5%. 45.9% of RLNs were anterior and 44.5% were posterior to the ITA, and 9.6% were crossing between the branches of the ITA. The rate of total VCP was 4.8% (transient:4.5%, permanent: 0.3%). The rates of total and transient VCP were significantly higher in extralaryngeal branching nerves compared to nonbranching nerves (6.8% vs. 3.6%, p = 0.018; 6.8% vs. 3.2%, p = 0.006, respectively). Total VCP rates were 7.2%, 2.5%, and 2.9% in case of the RLN crossing anterior, posterior and between the branches of ITA, respectively (p = 0.003). The difference was also significant regarding the transient VCP rates (p = 0.004). Anterior crossing pattern increased the total and transient VCP rates 2.8 and 2.9 times, respectively.
CONCLUSIONS: RLN crossing ITA anteriorly and RLN branching are frequent anatomical variations increasing the risk of VCP in thyroidectomy that cannot be predicted preoperatively. This study is the first one reporting that the relationship between RLN and ITA increased the risk of VCP.