갑상선 수술에서 비 회귀성 하후두 신경: 술 전 경부 CT의 유용성 및 임상적 고찰
Non-Recurrent Inferior Laryngeal Nerve in Thyroid Surgery: The Usefulness of Preoperative Neck CT and Clinical Review
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Background and Objectives The non-recurrent inferior laryngeal nerve (NRILN) represents a risk factor for nerve injury during thyroid surgery. The intraoperative identification and preservation of NRILN may be an extremely challenging procedure. It is associated with the developmentally absence of the brachiocephalic trunk and the presence of an aberrant subclavian artery, the so called “arteria lusoria”. The aim of this study is to investigate its prevalence and to verify the availability of preoperative neck CT in the research of NRILN by means of identification of arterial abnormalities and impact on NRILN morbidity. Subjects and Method Between January 1997 and July 2008, 1,639 patients underwent thyroid surgery. Of these cases, 1,469 cases (89.6%) were checked preoperative neck CT. Results Patients with preoperative neck CT, 10 cases (0.61%) show the absence of the brachiocephalic trunk and the retroesophageal aberrant right subclavian artery that arising directly form the aortic arch. Of these 10 cases, 9 cases (0.55%) NRILNs on the right side were exposed per-operatively. 7 cases were revealed high type (type I) of NRILN and 2 cases were low type (type II). There were no clinical symptoms such as dysphagia or dyspnea. The other 1 case was performed only left thyroidectomy, so we couldn’t identify the NRILN. In all cases, No vocal cord paralysis was observed. Conclusion Preoperative neck CT could correctly identify NRILN, allowing earlier nerve identification and subsequently reduce the risk of accidental nerve damages.
Abstract
Background and Objectives The non-recurrent inferior laryngeal nerve (NRILN) represents a risk factor for nerve injury during thyroid surgery. The intraoperative identification and preservation of NRILN may be an extremely challenging procedure. It is associated with the developmentally absence of the brachiocephalic trunk and the presence of an aberrant subclavian artery, the so called “arteria lusoria”. The aim of this study is to investigate its prevalence and to verify the availability of preoperative neck CT in the research of NRILN by means of identification of arterial abnormalities and impact on NRILN morbidity. Subjects and Method Between January 1997 and July 2008, 1,639 patients underwent thyroid surgery. Of these cases, 1,469 cases (89.6%) were checked preoperative neck CT. Results Patients with preoperative neck CT, 10 cases (0.61%) show the absence of the brachiocephalic trunk and the retroesophageal aberrant right subclavian artery that arising directly form the aortic arch. Of these 10 cases, 9 cases (0.55%) NRILNs on the right side were exposed per-operatively. 7 cases were revealed high type (type I) of NRILN and 2 cases were low type (type II). There were no clinical symptoms such as dysphagia or dyspnea. The other 1 case was performed only left thyroidectomy, so we couldn’t identify the NRILN. In all cases, No vocal cord paralysis was observed. Conclusion Preoperative neck CT could correctly identify NRILN, allowing earlier nerve identification and subsequently reduce the risk of accidental nerve damages.
참고문헌 (13)
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