甲状腺射频消融术中的神经损伤：机制、预防与实用管理

文献信息

中文摘要

背景： 声音改变是甲状腺射频消融术（RFA）一种不常见但临床上重要的并发症，因为它可能提示喉返神经损伤，或较少见的迷走神经损伤。早期识别和适当干预很重要，因为在发生不可逆的结构性神经损伤之前，神经功能障碍可能仍可逆转。方法：甲状腺RFA期间的热神经损伤并不总是单一瞬时事件。相反，它可能涉及神经的直接热暴露，导致急性神经内膜或神经周围水肿、微血管受损以及延迟性炎症或纤维化。结果：因此，甲状腺RFA期间声音改变的实用管理方法应强调预防、频繁的术中声音评估、立即停止消融以及迅速推注冷5%葡萄糖水。结论：在充分冷却后，可考虑局部注射地塞米松和短期口服皮质类固醇治疗。总之，基于机制的框架可能提高操作者的准备程度并降低持续性神经功能障碍的风险。

英文摘要

Voice change is an uncommon but clinically important complication of thyroid radiofrequency ablation (RFA), because it may indicate injury to the recurrent laryngeal nerve or, less commonly, the vagus nerve. Early recognition and appropriate intervention are important, because neural dysfunction may remain reversible before the occurrence of irreversible structural nerve injury. Thermal nerve injury during thyroid RFA is not always a single instantaneous event. Rather, it may involve direct thermal exposure of the nerves, leading to acute endoneurial or perineural edema, microvascular compromise, and delayed inflammation or fibrosis. Therefore, a practical approach to the management of voice changes during thyroid RFA should emphasize prevention, frequent intraprocedural voice assessment, immediate cessation of ablation, and prompt bolus injection of cold 5% dextrose in water. After adequate cooling, local dexamethasone injections and a short course of oral corticosteroid therapy may be considered. In conclusion, a mechanism-based framework may improve operator preparedness and reduce the risk of persistent nerve dysfunction.