Analysis of risk factors for recurrent laryngeal nerve injury in secondary thyroidectomy / 国际外科学杂志

ABSTRACT

Objective:Exploring the risk factors of recurrent laryngeal nerve injury in thyroid surgery.Methods:The hundred and sixteen patients undergoing secondary thyroid surgery from January 2016 to January 2019 were selected in the general surgery department of the First Affiliated Hospital of Harbin Medical University. The patients were divided into an injury group ( n=20) and a control group ( n=296) according to whether the recurrent laryngeal nerve injury occurred after the secondary operation. SPSS 23.0 was used to perform univariate analysis and multivariate regression analysis. Results:The total injury rate of recurrent laryngeal nerve in secondary thyroid surgery was 6.33% (20/316). In the univariate analysis, the size of the thyroid, the first operation, the interval between two operations, the tumor aggressiveness, the secondary operation, and whether nerve monitoringa were statistically significant in the injury group and the control group( χ2=1.495, 1.503, 1.628, 1.299, 1.938, 1.262, P<0.05). Logistic regression analysis showed that the size of the thyroid gland ( OR=4.962, P=0.001), the first operation ( OR=12.296, P=0.002), the interval between two operations ( OR=3.590, P=0.025) and the secondary operation ( OR=2.319, P=0.002) were an independent risk factors for recurrent laryngeal nerve injury in secondary thyroid surgery. Conclusions:Secondary thyroid surgery is more likely to cause recurrent laryngeal nerve damage. For the thyroid disease with a high risk of recurrence, total thyroidectomy should be selected for the first surgery to to avoid the risk of complications caused by secondary surgery; For some complicated secondary surgery patients, the use of recurrent laryngeal nerve monitoring technology during operation can minimize the recurrent laryngeal nerve injury and improve the patient′s postoperative quality of life.