甲状腺手术后声嘶原因分析

摘要

目的 探讨甲状腺手术后引起患者声音嘶哑的原因.方法 分析乐山市人民医院2010年12月～2015年12月期间甲状腺手术508例、非甲状腺手术全麻患者503例和随机抽样正常人志愿者100例;508例甲状腺手术患者又根据术中是否暴露喉返神经,分为暴露组297例和非暴露组211例,比较暴露喉返神经是否对声嘶有影响;对1011例全部手术患者和100例正常志愿者焦虑自评量表(SAS)焦虑评分,1011例按术后是否声嘶分为非声嘶组995例和声嘶组16例,100例正常人志愿者为对照组,统计分析精神因素对声嘶是否影响;评估503例非甲状腺全麻患者术后是否出现声嘶,通过喉镜检查观察气管插管对声嘶的影响;统计不同手术方式是否对声嘶有影响,通过对声嘶病人的随访,观察声嘶患者声音能否恢复正常以及恢复正常时间.结果 甲状腺不同手术方式声嘶组间两两比较,暴露喉返神经组与非暴露喉返神经组比较,无明显统计学意义(P＞0.05);声嘶组SAS焦虑评分明显高于非声嘶组及对照组(P＜0.05),声嘶组和非声嘶组明显高于对照组(P＜0.05);通过对503例非甲状腺全麻手术病人术后一周的观察,非甲状腺手术也可导致声嘶,考虑为麻醉引起.结论 甲状腺手术单纯暴露喉返神经不会明显降低声嘶率,术后出现声嘶不仅仅是因为对喉返神经的损伤,影响声嘶发生的还可能有患者声带本身就有疾病、气管插管或拔管及其他原因对声带的损伤,还有术前精神因素的影响,均可能使患者术后出现声嘶.%Objective To discuss the causes of hoarseness after thyroid surgery.Methods 508 patients with thyroid surgery,503 patients with general anesthesia and without thyroid surgery and 100 normal people were involved in the present study.508 patients with thyroid surgery were divided into exposure group (297 cases with exposure of recurrent laryngeal nerve) and non-exposure group (211 cases without exposure of recurrent laryngeal nerve).The anxiety of subjects was scored with SAS anxiety score.1011 patients were divided into hoarseness group (16 cases) and non-hoarseness group (995 cases) and controlled with normal volunteers (control group,100 cases).The effect of psychological factors,operation and tracheal intubation on hoarseness was analyzed.The patients were followed up to observe the recovery of hoarseness.Results The incidence of hoarseness of exposure group and non-exposure group were not different (P＞0.05).SAS score of hoarseness group was higher than that of non-hoarseness group (P＜0.05).SAS score of hoarseness group and non-hoarseness group were higher than that of control group (P＜0.05).The hoarseness might induce by general anesthesia,because there were hoarseness patients in general anesthesia and without thyroid surgery.Conclusion Exposure of recurrent laryngeal nerve in thyroid surgery cannot significantly reduce the rate of hoarseness.The causes of postoperative hoarseness is not only recurrent laryngeal nerve damage,but also the vocal cord disease,endotracheal intubation and preoperative psychological factors.