CAJ | 학술논문

目的探索喉返神经直接端端吻合的疗效和临床应用价值.方法分别采用显微镜、放大镜和肉眼3种条件下对15例甲状腺手术中单侧喉返神经切断伤或因肿瘤侵犯切除者行神经直接端端吻合,26例未行神经修复者作为对照组.根据患者本人和听者的主观感受,从呼吸、发声、自我感受等方面进行疗效评价和比较分析,9例神经吻合者和12例神经未修复者行电子纤维喉镜检查声带运动和喉结构的变化并比较分析.结果 14例喉返神经吻合者在术后2～5个月声音嘶哑恢复至术前正常发音;电子纤维喉镜见喉结构对称,声带张力好,发声时声门闭合好,尽管声带无明显生理运动,但视频下发声时可见杓状软骨轻微内收运动;末行神经修复的26例中仅2例声嘶恢复至接近术前正常发声,声嘶未恢复者患侧杓状软骨固定,不同程度喉萎缩,发声时声门关闭不严.结论神经直接端端吻合能有效恢复单侧喉返神经切断伤患者的正常呼吸和发音,且操作简便易行.
목적 탐색후반신경직접단단문합적료효화림상응용개치.방법 분별채용현미경、방대경화육안3충조건하대15례갑상선수술중단측후반신경절단상혹인종류침범절제자행신경직접단단문합,26례미행신경수복자작위대조조.근거환자본인화은자적주관감수,종호흡、발성、자아감수등방면진행료효평개화비교분석,9례신경문합자화12례신경미수복자행전자섬유후경검사성대운동화후결구적변화병비교분석.결과 14례후반신경문합자재술후2～5개월성음시아회복지술전정상발음;전자섬유후경견후결구대칭,성대장력호,발성시성문폐합호,진관성대무명현생리운동,단시빈하발성시가견표상연골경미내수운동;말행신경수복적26례중부2례성시회복지접근술전정상발성,성시미회복자환측표상연골고정,불동정도후위축,발성시성문관폐불엄.결론 신경직접단단문합능유효회복단측후반신경절단상환자적정상호흡화발음,차조작간편역행.
Objective To investigate the necessity of primary neurorrhaphy (direct end-to-end anastomosis) when the recurrent laryngeal nerve(RLN) is severed during thyroid surgery.Methods 15 patients who suffered from iaotmgenic unilateral complete RLN injury or whose unilateral RLN had to be sacrificed because of disease invasion had a primary repair of RLN by direct end-to-end anastomosis.In control group,26 patients who did not have a nerve repair were enrolled into this study.Subjective evaluation of aspiration and voice quality were based on patient reports and hearer reports for all patients.9 patients with neurorrhaphy and 12 patients without nerve repair were followed with videolaryngoscopic examination.Results 14 patients undergoing neurorrhaphy restored normal voice at 2-5 months postoperatively.Although there were no significant functional motion of the vocal fold,slight adductory movement of the affected arytenoid was found with good tension vocal cords and symmetric arytenoids of the glottis during phonation.Only 2 patients without nerve repair had nearly restored normal voice.The patients with hoarseness had stiff arytenoids and atrophic folds resulting in glottal gap.Conclusions Neurorrhaphy is a simple and effective method to restore the normal aspiration and voice quality of patients with unilateral complete recurrent laryngeal nerve injuries.