Immediate Ansa Cervicalis-to-Recurrent Laryngeal Nerve Anastomosis for the Management of Recurrent Laryngeal Nerve Infiltration by a Differentiated Thyroid Carcinoma
Immediate Ansa Cervicalis-to-Recurrent Laryngeal Nerve Anastomosis for the Management of Recurrent Laryngeal Nerve Infiltration by a Differentiated Thyroid Carcinoma
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即刻颈安莎喉返神经吻合术治疗分化型甲状腺癌喉返神经浸润
DOI：
10.1159/000505129
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Fei Liu(共同第一作者）
中科院分区：
文献类型：
--
作者：
Fei Liu(共同第一作者）
目的：分化型甲状腺癌(DTC)喉返神经(RLN)浸润性病变的最佳手术入路仍存在争议。本研究探讨直接吻合颈神经(ACN)与喉返神经(RLN)在DTC治疗喉返神经浸润性病变中的可行性和有效性。材料和方法：53例DTC摘除手术中即刻行ACN-RLN吻合术的患者。37例术前出现单侧声带麻痹(A组)，16例术前声带活动度正常(B组)。术前、术后进行多维评估、频闪检查、嗓音评估和喉部肌电(LEMG)检查。结果：与术前比较，A组术后1个月、术后1年、术后1个月、术后1年的各项指标均较术前下降，术后1年有所改善。B组术后1年各项指标较术后1个月均有明显改善。A组和B组的LEMG为ACN神经再生的成熟提供了充分的证据，并证明了该方法成功地对喉肌进行了神经再生。结论：如果喉返神经被DTC侵犯，在DTC完全切除时立即行ACN-RLN吻合术，可恢复满意的发声功能，不影响肿瘤的根治性。
Objectives: The optimal surgical approach to treat recurrent laryngeal nerve (RLN) infiltration by differentiated thyroid cancer (DTC) remains a subject of debate. This study explored the feasibility and efficiency of immediate ansa cervicalis nerve (ACN)-to-RLN anastomosis for the management of RLN infiltration by DTC. Material and Methods: Fifty-three patients who underwent immediate ACN-to-RLN anastomosis during DTC extirpation were enrolled in the present study. Thirty-seven cases presented with unilateral vocal cord paralysis before the operation (Group A), and another 16 patients presented with normal vocal cord mobility preoperatively (Group B). Multidimensional assessments, videostroboscopy, voice assessment, and laryngeal electromyography (LEMG) were performed preoperatively and postoperatively. Results: All videostroboscopy, voice assessment and LEMG parameters in Group A deteriorated 1 month after the operation and improved 1 year after the operation compared with preoperative data. In Group B, all parameters 1 year after the operation improved significantly compared with the corresponding parameters 1 month after the operation. LEMG in Group A and B provided substantial evidence for the maturation of neural regeneration from ACN and demonstrated that the laryngeal muscles were reinnervated successfully by this procedure. Conclusions: If the RLN is infiltrated by DTC, immediate ACN-to-RLN anastomosis during complete excision of DTC could restore satisfactory phonatory function and does not compromise oncological radicality.