Exposure and protection of recurrent laryngeal nerve in the reoperation for thyroid diseases / 中华内分泌外科杂志

ABSTRACT

Objective To investigate the exposure and protection of recurrent laryngeal nerve (RLN) in the reoperation for thyroid diseases.Methods Clinical data of 214 cases undergoing thyroid reoperation were retrospectively analyzed.The patients with a short interval between the 2 thyroid operations or with external-infiltrated thyroid cancer were approached at the lateral strap muscles and the leading edge of the sternocleidomastoid.RLNs were exposed in the lateral region of superior mediastinum tracheoesophageal groove or at the point where RLN enters to throat.RLNs of patients with lymph node metastasis were exposed beside the enlarged lymph nodes.The patients with a long interval between the 2 thyroid operations and with benign tumor or tumor without external infiltration were exposed their thyroids at the anterior midline and then RLNs were exposed at the posterior lateral of the middle thyroid veins or at the inferior thyroid artery.Results Among the 214 cases,344 RLNs were anatomically exposed including 188 right and 156 left.84 cases had single exposure and 130 cases had bilateral exposure.44 RLNs were exposed at the point where RLN enters to throat,104 RLNs at the posterior lateral of the middle thyroid veins,40 RLNs at the inferior thyroid artery,124 RLNs at the lateral region of superior mediastinum tracheoesophageal groove,and 32 RLNs beside the enlarged lymph nodes.For the 2 cases suffering hoarse voice the day after they underwent thyroid operation in other hospital,suture ligation at the the entrance point was found when they received the reoperation in our hospital.Three of the total 344 RLNs (0.87％ ) had RLN branch injury in the entire group.Conclusion It is possible to reduce RLN injury during the reoperation for thyroid disease if surgeons are familiar with the dissection of RLN under normal or pathological condition,avoid adhesive or scar tissues,and select the appropriate anatomic approach.