Comparison of vocal outcome following two different procedures for immediate RLN reconstruction
Comparison of vocal outcome following two different procedures for immediate RLN reconstruction
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DOI：
10.1007/s00405-015-3852-x
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发表时间：
2016-04-01
影响因子：
2.6
通讯作者：
Yumoto, Eiji
中科院分区：
文献类型：
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作者：
Kumai, Yoshihiko;Kodama, Narihiro;Yumoto, Eiji
本研究的目的是比较在颈部肿瘤摘除术中立即重建喉返神经（RLN）的两种不同手术后发音功能和频闪检查结果的时间依赖性改善。17例颈部肿瘤患者，包括晚期甲状腺癌（n = 15），其他恶性病变的颈部淋巴结转移（n = 2），接受了原发病灶切除术，并涉及喉返神经。从2000年至2011年，通过（1）颈袢神经（ACN）与喉返神经吻合术（n = 8）或（2）在喉返神经切断端之间放置耳大神经（GAN）（n = 9）进行即刻喉返神经重建。术后1个月、6个月和12个月检查了发声功能[最大发声时间、平均气流速率（MFR）、抖动和闪烁）和频闪镜检查结果（规则性、振幅和声门间隙）。频闪检查结果由两名耳鼻喉科医生和一名语言病理学家进行评估。在术后1个月时，除了抖动和微光外，ACN和GAN之间的发声功能或频闪检查结果的任何参数均无显著差异，其中ACN上级GAN。术后1 ~ 12个月，发声功能和频闪检查结果均明显改善（P < 0.05）。在颈部肿瘤摘除时立即重建喉返神经的任何一种方法（即，ACN或GAN）提供了良好的术后长期发声功能和频闪检查结果，两种手术之间的发声结果几乎没有差异。
The objective of this study was to compare time-dependent improvements in phonatory function and stroboscopic findings following two different procedures for immediate reconstruction of the recurrent laryngeal nerve (RLN) during neck tumor extirpation. Seventeen patients with neck tumors, consisting of advanced thyroid cancer (n = 15), metastatic neck lymph nodes from other malignant lesions (n = 2), underwent resection of the primary lesion and involved RLN. Immediate RLN reconstruction by either: (1) ansa cervicalis nerve (ACN) to RLN anastomosis (n = 8); or (2) placement of the great auricular nerve (GAN) between the cut ends of the RLN (n = 9) was performed from 2000 to 2011. Phonatory function [maximum phonation time, mean airflow rate (MFR), jitter, and shimmer) and stroboscopic findings (regularity, amplitude, and glottal gap) were examined at 1, 6, and 12 months postoperatively. Stroboscopic findings were assessed by two otolaryngologists and one speech pathologist. There were no significant differences in any parameter for either phonatory function or stroboscopic findings between ACN and GAN with the exception of jitter and shimmer, in which ACN was superior to GAN at 1 month postoperatively. All parameters improved significantly between 1 and 12 months postoperatively for both phonatory function and stroboscopic findings (P < 0.05). Either method of immediate RLN reconstruction at the time of neck tumor extirpation (i.e., ACN or GAN) provided both excellent long-term postoperative phonatory function and stroboscopic findings, and there was little difference in vocal outcome between the two procedures.