【摘要】 目的分析术前单侧喉返神经麻痹的甲状腺肿瘤患者的临床、病理特点,探讨合理处理受侵喉返神经的方法。方法回顾分析2004年5月~2008年12月收治的2 174例甲状腺肿瘤患者的临床资料,其中19例术前诊断单侧喉返神经麻痹,包括结节性甲状腺肿2例,甲状腺恶性肿瘤17例。13例行根治性切除手术,包括双侧甲状腺切除+颈淋巴结清除术12例,双侧甲状腺切除+全喉切除术1例,其中6例保留喉返神经,1例切除受侵段神经后予以吻合,另6例切除病变神经;4例行姑息性切除,患侧喉返神经均切除;2例结节性甲状腺肿患者行双侧甲状腺全切除术,喉返神经保护。结果 19例患者均无围手术期死亡病例。淋巴结转移者10例。19例均获随访,时间平均64(37~91)月。2例结节性甲状腺肿和6例甲状腺癌术中保留喉返神经者,术后声音改善明显,另1例健侧代偿。6例切除神经者和4例姑息性手术切除喉返神经者术后声音无改善。结论术中探明喉返神经受肿瘤侵犯程度,尽可能保留神经,可以改善患者生活质量,取得较满意治疗效果。更多还原

【Abstract】 Objective To assess the clinical and pathological features of thyroid tumors with unilateral recurrent laryngeal nerve(RLN) paralysis detected before surgery,and explore better appropriate treatment strategies.Methods The clinical data of 2,174 thyroid tumor patients admitted from May 2004 to December 2008 were reviewed.Among of them,19 thyroid tumor patients were diagnosed unilateral RLN paralysis preoperatively,including nodular goiter in 2 and malignancy in 17.13 cases were performed radical excision,including 12 of bilateral thyroidectomy and radical neck dissection and 1 of bilateral thyroidectomy and total laryngectomy.Of the 13 cases,RLN was preserved in 6,anastomosis after invaded segment excision in 1,and ablated in 6 cases.4 cases were carried out palliative resection and RLN excision.2 nodular goiter cases received bilateral thyroidectomy and RLN preservation.Results There was no peri-operative death in all 19 patients.Lymph node metastasis was found in 10 cases.All 19 cases were followed up for 37 to 91 months with an average of 64 months.The function of vocal cord was recovered in 2 nodular goiter cases and 6 thyroid cancer cases received RLN preservation,was achieved contralateral compensation in one case performed RLN preservation,and was not improved in 6 cases performed RLN excision and 4 cases received palliative resection and RLN resection.Conclusion The intra-operative measures of routine exposure of the invaded RLN and preservation of RLN can improve the function of vocal cord and quality of life for patients with thyroid tumors.更多还原