喉返神经端端吻合的疗效与临床应用价值.pdf

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1、中华普通外科杂志2014年7月第29卷第7期ChinJGenSurg，July2014，Vo1．29，No．7·527·．论著．喉返神经端端吻合的疗效与临床应用价值刘文胜张彬倪晓光李德志张国芬鄢丹桂【摘要】目的探索喉返神经直接端端吻合的疗效和临床应用价值。方法分别采用显微镜、放大镜和肉眼3种条件下对15例甲状腺手术中单侧喉返神经切断伤或因肿瘤侵犯切除者行神经直接端端吻合，26例未行神经修复者作为对照组。根据患者本人和听者的主观感受，从呼吸、发声、自我感受等方面进行疗效评价和比较分析，9例神经吻合者和12例神经未修复

2、者行电子纤维喉镜检查声带运动和喉结构的变化并比较分析。结果14例喉返神经吻合者在术后2～5个月声音嘶哑恢复至术前正常发音；电子纤维喉镜见喉结构对称，声带张力好，发声时声门闭合好，尽管声带无明显生理运动，但视频下发声时可见杓状软骨轻微内收运动；未行神经修复的26例中仅2例声嘶恢复至接近术前正常发声，声嘶未恢复者患侧杓状软骨固定，不同程度喉萎缩，发声时声门关闭不严。结论神经直接端端吻合能有效恢复单侧喉返神经切断伤患者的正常呼吸和发音，且操作简便易行。【关键词】喉返神经损伤；声带麻痹；吻合术，外科；语音质量Clinica

3、levaluationofend·-to-endneurorrhaphyforunilateralrecurrentlaryngealnervetransactioninjuryLiuWensheng，ZhangBin，NiXiaoguang，LiDezhi，ZhangGuofen，ranDangui．DepartmentofHeadandNeckSurgery，CancerHospital，ChineseAcademyofMedicalSciences，Bering100021，ChinaCorrespondin

4、gauthor：LiuWensheng，E—mail：1wsdoct@aliyun．com【Abstract】objectiveToinvestigatethenecessityofprimaryneurorrhaphy(directend—to—endanastomosis)whentherecurrentlaryngealnerve(RLN)isseveredduringthyroidsurgery．Methods15patientswhosufferedfromiaotrogenicunilateralcom

5、pleteRLNinjuryorwhoseunilateralRLNhadtobesacrificedbecauseofdiseaseinvasionhadaprimaryrepairofRLNbydirectend—to—endanastomosis．Incontrolgroup，26patientswhodidnothaveanerverepairwereenrolledintothisstudy．Subjectiveevaluationofaspirationandvoicequalitywerebasedo

6、npatientreportsandhearerreportsforallpatients．9patientswithneurorrhaphyand12patientswithoutnerverepairwerefollowedwithvideolaryngoscopicexamination．Results14patientsundergoingneurorrhaphyrestorednormalvoiceat2—5monthspostoperatively．Ahhoughtherewerenosignifica

7、ntfunctionalmotionofthevocalfold，slightadductorymovementoftheaffectedarytenoidwasfoundwithgoodtensionvocalcordsandsymmetricarytenoidsoftheglottisduringphonation．Only2patientswithoutnerverepairhadnearlyrestorednormalvoice．Thepatientswithhoarsenesshadstifaryteno

8、idsandatrophicfoldsresultinginglottalgap．ConclusionsNeurorrhaphyisasimpleandeffectivemethodtorestorethenormalaspirationandvoicequalityofpatientswithunilateralcompleterecurrentlaryn