即刻双侧喉返神经重建后气道狭窄：两例经激光黏膜下杓状软骨中间横切术成功治疗的病例报告

文献信息

中文摘要

背景： 虽然已有报道表明术中即刻单侧喉返神经（RLN）重建的有效性，但关于双侧重建的报道很少。此外，对于双侧RLN麻痹所致气道受损，手术治疗前后喉功能的详细评估仍然有限。本报告旨在强调即刻双侧RLN重建的一种可预防并发症及一种补救治疗方案。
病例描述： 我们报告了两名女性患者，她们在另一家医院因良性甲状腺肿瘤手术期间接受了即刻双侧RLN重建，随后发生了气道狭窄。两名患者均接受了术中气管切开术，并被转诊至我院以进行气管造口闭合。喉肌电图显示吸气期间甲杓肌活动，发声期间活动减弱，提示神经错向支配。在手术前后评估了呼吸、吞咽和语音功能。采用激光黏膜下杓状软骨中间横切术（LSITRA）技术扩大后声门。在两例患者中，术后呼吸功能均改善，气管造口成功闭合，且在拔管后超过1年的随访期间未观察到再狭窄。
结论： LSITRA对治疗双侧RLN麻痹所致气道狭窄有效，对语音和吞咽功能的不良影响极小。虽然即刻RLN重建对单侧神经损伤有效，但应避免双侧重建，因为错向支配可能导致气道受损。在良性甲状腺疾病中，当一侧检测到信号丢失时，应考虑两阶段手术方案。

英文摘要

BACKGROUND: While the usefulness of immediate intraoperative reconstruction of the unilateral recurrent laryngeal nerve (RLN) has been reported, there are few reports of bilateral reconstruction. Furthermore, detailed evaluation of laryngeal function before and after surgical treatment for airway compromise caused by bilateral RLN paralysis remains limited. This report aimed to highlight a preventable complication of immediate bilateral RLN reconstruction and a salvage treatment option.
CASE DESCRIPTION: We report two women who underwent immediate bilateral RLN reconstruction during surgery for benign thyroid tumors at another hospital and subsequently developed airway stenosis. Both patients underwent intraoperative tracheostomy and were referred to our institution for tracheostomy closure. Laryngeal electromyography revealed thyroarytenoid muscle activity during inspiration and reduced activity during phonation, indicating nerve misinnervation. Respiratory, swallowing, and voice functions were evaluated before and after surgery. The laser submucosal intermediate transverse resection of the arytenoid cartilage (LSITRA) technique was performed to enlarge the posterior glottis. In both cases, respiratory function improved after surgery, tracheostomies were successfully closed, and no restenosis was observed during more than 1 year of follow-up after decannulation.
CONCLUSIONS: LSITRA was effective for treating airway stenosis caused by bilateral RLN paralysis, with minimal adverse effects on voice and swallowing function. Although immediate RLN reconstruction is effective for unilateral nerve injury, bilateral reconstruction should be avoided because misinnervation may result in airway compromise. In benign thyroid disease, a two-stage surgical approach should be considered when loss of signal is detected on one side.