Mechanisms of recurrent laryngeal nerve injury near the nerve entry point during thyroid surgery: A retrospective cohort study

INTERNATIONAL JOURNAL OF SURGERY

卷:83

Article

Liu, Nan¹  Chen, Bo¹  Li, Luchuan¹  Zeng, Qingdong¹  Sheng, Lei¹  Zhang, Bin¹  Liang, Weili¹  Lv, Bin¹ 

[1] Shandong Univ, Qilu Hosp, Dept Gen Surg, Jinan 250012, Shandong, Peoples R China

关键词: Thyroid surgery;    Recurrent laryngeal nerve;    Surgical complication;    Intraoperative neuromonitoring;    Recovery time;   

DOI  :  10.1016/j.ijsu.2020.08.058

来源: Elsevier

【 摘 要 】

Background: The use of intraoperative neuromonitoring (IONM) for visual identification of recurrent laryngeal nerve (RLN) has decreased the rates of RLN injury (RLNI) during thyroid surgery. However, little attention has been paid to RLNI near the nerve entry point (NEP), where most injuries occur. The aim of this study was to determine the mechanism of RLNI near the NEP and to describe the recovery of nerve function. Methods: Patients undergoing thyroid surgery were analyzed to identify true loss of signal (LOS) by IONM. Follow-up for vocal cord palsy (VCP) was confirmed by a postoperative laryngoscopy. The risk factors for RLNI, the type of RLNI, the prevalence of VCP and the time for VCP recovery were all recorded and analyzed. Results: We analyzed 3582 at-risk nerves in 2257 surgical patients. The overall rate of RLNI near the NEP in atrisk nerves was 3.2%. RLNI was more likely to occur in nerves with extralaryngeal bifurcation (p = 0.013). The distribution of RLNI types, in order of frequency, was traction (52.6%; n = 61), compression (38.8%; n = 45), thermal (7.8%; n = 9), and nerve transection (0.9%; n = 1). Complete recovery from VCP was documented in 93.1% (n = 108) of RLNI. Conclusion: Patients with a bifurcated RLN were at a higher risk of RLNI near the NEP than those without bifurcation. Traction and compression injuries occurred most frequently, but would eventually recover. Excessive stretching of the thyroid lobe played a role in RLNIs near the NEP.

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