【摘要】 目的:探讨神经减压治疗对早期甲状腺手术所致的双侧喉返神经麻痹的可行性及疗效。方法:按标准纳入2007年9月至2014年7月期间在我院就诊的18例因甲状腺手术所致的双侧喉返神经麻痹、病程在4个月以内并行喉返神经探查术的患者,电子喉镜观察所有病例术前和术后的声带活动度和声门闭合情况判定喉返神经功能恢复情况。结果:18例双侧喉返神经损伤的患者中有8例是由单次手术所致,有10例二次手术所致。单次手术致双侧喉返神经损伤的8例患者中,6例行神经减压治疗者(4例双侧减压,2例单侧减压)均于术后3个月内实现拔管。其中有1例单侧声带外展略受限,1例双侧声带活动度略差。二次甲状腺手术的10例患者中7例神经被结扎行减压术者均于术后2~4个月内拔管,除1例患者单侧声带外展稍差外,余6例声带活动度恢复正常,发声满意,未再出现呼吸困难症状。结论:对由于甲状腺手术所导致的双侧喉返神经麻痹,应尽量在损伤3~4个月内行喉返神经探查及减压术,可使其恢复成为单侧喉返神经麻痹或完全正常的状态,发声满意,从而有效改善呼吸,且远期效果好。更多还原

【Abstract】 Objective: To explore the feasibility and curative effect of recurrent laryngeal nerve decompression in the treatment of early bilateral recurrent laryngeal nerve paralysis caused by thyroid operation. Methods: According to the standards,18 cases for this retrospective prognostic study were drawn from the patient database for bilateral recurrent laryngeal nerve paralysis caused by thyroid operation in our hospital from September 2007 to July 2014,whose course in 4 months or less and needed to do parallel recurrent laryngeal nerve exploration. The recovery of function of recurrent laryngeal nerve was detected to the recovery of vocal cord mobility through electrolaryngoscope postopertively. Results: Operating found that 8 patients were caused by a single operation and 10 cases by operation two in 18 cases of bilateral recurrent laryngeal nerve injury. 3 months after nerve decompression,the cure state of 8 cases of bilateral recurrent laryngeal nerve injury caused by single operation was that 6 cases extubation,1 case with unilateral vocal fold abduction limitation and 1 case of bilateral vocal cord activity slightly difficult.After decompression of two thyroid operations,the cure state of 7 cases whose recurrent laryngeal nerves were ligated was that all of them extubation in 2 to 4 months,and 1 case with unilateral vocal fold abduction limitation,6 cases of vocal cord activity returned to normal with no dyspnea. Conclusion: It is important to do recurrent laryngeal nerve exploration and decompression as far as possible in the 3 to 4 months after injury,which is good at recovery to a unilateral recurrent laryngeal nerve paralysis or completely normal state,so as to effectively improve the breathing and tracheal cannula removed.更多还原