Recurrent Laryngeal Nerve A Plexus Rather Than a Nerve?
Recurrent Laryngeal Nerve A Plexus Rather Than a Nerve?
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DOI：
10.1001/archoto.2009.151
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发表时间：
2009-11-01
影响因子：
--
通讯作者：
Brandao, Lenine G.
中科院分区：
文献类型：
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作者：
Cernea, Claudio R.;Hojaij, Flavio C.;Brandao, Lenine G.
目的：分析喉返神经（RLN）喉外分支（ELB）的频率在连续的一系列患者接受甲状腺切除术的同一组外科医生在较长时间内，并比较我们的发现与文献资料。设计：回顾性病历研究。设置：学术研究。患者：1983年3月1日至2008年9月30日，2677例患者行甲状腺切除术。其中，1638例患者有至少1例RLN的手术信息。共1081例患者接受了双侧手术。在研究的最后5年中，我们使用市售系统对选定的患者进行术中喉神经监测。主要结局指标：获得了2154例RLNs的信息。结果：共1390例RLNs（64.53%）存在ELB。在447例术中使用喉神经监测的患者中，前支通常表现出更多的电生理活动。结论：在本病例系列中，64.53%的RLNs发现咽外分支。在最近的患者术中喉神经监测，电生理活动被观察到分支，特别是位于前面的分支。认识到这种常见的解剖结构，并仔细保存所有分支，对于减少甲状腺切除术后的并发症至关重要。
Objectives: To analyze the frequency of extralaryngeal branching (ELB) of the recurrent laryngeal nerve (RLN) in a consecutive series of patients undergoing thyroidectomy by the same group of surgeons during an extended period and to compare our findings with the data available in the literature.Design: Retrospective medical record study.Setting: Academic research.Patients: From March 1, 1983, to September 30, 2008, 2677 patients underwent thyroidectomy. Of these, 1638 patients had surgical information about at least 1 RLN. A total of 1081 patients underwent bilateral operations. During the last 5 years of the study, intraoperative laryngeal nerve monitoring was performed in selected patients using a commercially available system.Main Outcome Measures: Information was obtained regarding 2154 RLNs.Results: A total of 1390 RLNs (64.53%) had ELB. Among 447 patients in whom intraoperative laryngeal nerve monitoring was used, the anterior branches usually exhibited more electrophysiologic activity.Conclusions: Extralaryngeal branching was found in 64.53% of RLNs in this case series. In recent patients with intraoperative laryngeal nerve monitoring, electrophysiologic activity was observed in the branches, particularly the anteriorly situated ones. Recognition of this frequent anatomical configuration and meticulous preservation of all branches are of paramount importance to decrease postoperative morbidity associated with thyroidectomy.