胸主动脉手术后复发性喉神经损伤后的功能结局。
Functional outcome after recurrent laryngeal nerve injury following thoracic aortic surgery.
文献信息
| PMID | 42887698 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Fabio Pregaldini |
| 作者单位 | Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: fabiomatteo.pregaldini@extern.insel.ch. |
| 期刊 | The Journal of thoracic and cardiovascular surgery |
| SCI 分区 | Q1 |
| IF | 5 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 复发性喉神经损伤是主动脉手术公认的并发症，然而关于长期功能结局的数据仍然有限。本研究旨在评估胸主动脉手术后复发性喉神经损伤的发生率，并评估嗓音恢复情况。
方法： 单中心回顾性分析纳入2001年至2024年间接受主动脉弓或胸腹主动脉手术的成年患者。复发性喉神经损伤通过术后声带麻痹诊断。主动脉弓手术包括部分和全主动脉弓置换，而胸腹手术涉及近端降主动脉。主要终点为嗓音完全恢复。次要终点包括声带活动度恢复正常、残余发声困难、需要嗓音治疗以及声带干预。
结果： 在2,983例接受主动脉手术的患者中，70例（2.3%）被诊断为术后复发性喉神经损伤。中位随访时间为17[IQR：7-25]个月。主动脉弓手术后复发性喉神经损伤的发生率为1.7%，胸腹手术后为5.3%。在最终随访时，34例患者（50%）实现嗓音完全恢复，而20例（30%）有轻度发声困难，9例（13%）有中度发声困难，5例（7%）有重度发声困难。49例（70%）患者接受了嗓音治疗，10例（14%）需要额外的声带干预。
结论： 在这个大型队列中，主动脉手术后复发性喉神经损伤的发生率低于既往报道。功能结局良好，大多数患者通过保守或介入管理实现了完全或接近完全的嗓音恢复。结构化随访和多学科护理对于优化复发性喉神经损伤后的结局仍然至关重要。
英文摘要
OBJECTIVES: Recurrent laryngeal nerve injury is a recognized complication of aortic surgery, yet data on long-term functional outcomes remain limited. This study aimed to evaluate the incidence of recurrent laryngeal nerve injury and to assess voice recovery after thoracic aortic surgery.
METHODS: Single-centre retrospective analysis included adult patients undergoing aortic arch or thoracoabdominal aortic surgery between 2001 and 2024. Recurrent laryngeal nerve injury was diagnosed by postoperative vocal cord paralysis. Aortic arch surgery included partial and total arch replacement, while thoracoabdominal surgery involved the proximal descending aorta. The primary endpoint was full voice recovery. Secondary endpoints included recovery of normal vocal cord mobility, residual dysphonia, the need for voice therapy, and vocal cord interventions.
RESULTS: Among 2,983 patients undergoing aortic surgery, 70 (2.3%) were diagnosed with postoperative recurrent laryngeal nerve injury. Median follow-up was 17 [IQR: 7-25] months. The incidence of recurrent laryngeal nerve injury was 1.7% after arch surgery and 5.3% after thoracoabdominal procedures. At final follow-up, 34 patients (50%) achieved full voice recovery, while 20 (30%) had mild dysphonia, 9 (13%) moderate dysphonia, and 5 (7%) severe dysphonia. Voice therapy was performed in 49 (70%) patients, and 10 (14%) required additional vocal cord interventions.
CONCLUSIONS: In this large cohort, the incidence of recurrent laryngeal nerve injury after aortic surgery was lower than previously reported. Functional outcomes were favourable, with most patients achieving full or near-complete voice recovery through conservative or interventional management. Structured follow-up and multidisciplinary care remain essential to optimize outcomes after recurrent laryngeal nerve injury.