Sinan KOCATÜRK, Ünsal ERKAM

11719

Tiroit cerrahisinde rekürrent larenjeal sinire yaklaşımımız

Amaç: Tiroidektomi yapılan olgularda rekürrent larengeal sinirin RLS tanınmasına yönelik mikroskobik yaklaflımımız ve RLS diseksiyonu ile ilgili komplikasyonlar değerlendirildi.Hastalar ve Yöntemler: Çalıflmaya tiroidektomi yapılan 23 hasta 20 kadın, 3 erkek; ort. yafl 37 alındı.On altı hastada tek taraflı, yedi hastada iki taraflı olmak üzere toplam 30 RLS diseksiyonu yapıldı. Tümolgularda, 250 mm oküler lens takılı ameliyat mikroskobu kullanılarak RLS inferior torasik giriflte bulunduve larenkse girifl yerine kadar total diseksiyon yapıldı. Hastalarda kord vokal hareketlerini değerlendirmeye yönelik endoskopik larenjeal muayenelerameliyattan bir gün önce ve ameliyat sonrası 1, 3 ve7. günlerde yapıldı.Bulgular: Ameliyattan önceki muayenelerde hiçbirhastada kord vokal hareket bozukluğu görülmedi.Ameliyat sonrasında kalıcı RLS paralizisine rastlanmazken, iki hastada geçici RLS parezisi kord vokalhareket kısıtlılığı gözlendi. Sinir diseksiyonununmikroskop ile yapılmasının ameliyat süresini tek sinir için 15-40 dakika arasında uzattığı görüldü; ancak bu sürenin cerrahın deneyimi arttıkça düfltüğügözlendi. Sonuç: Tiroidektomi sırasında ameliyat mikroskobukullanımının RLS diseksiyonunda güvenilir bir yaklaflım olduğu sonucuna varıldı
Anahtar Kelimeler:

Paratiroidektomi, rekürrent larenjeal sinir, anatomi ve histoloji/yaralanma, tiroit hastalıkları/cerrahi, tiroit bezi/kan desteği, tiroidektomi

Approach to the recurrent laryngeal nerve in thyroid surgery

Objectives: We evaluated our surgical approach to the identification of the recurrent laryngeal nerve RLN under the guidance of operation microscope and RLN dissections during thyroidectomy.Patients and Methods: Twenty-three patients 20 females, 3 males; mean age 37 years undergoing thy­ roidectomy were included in the study. Thirty RLN dis­ sections were performed, being unilateral in 16 patients, and bilateral in seven patients. The recurrent laryngeal nerveswere identifiedatthe inferior thoracic inlet with the use of the operation microscope having an ocular lens of 250 mm, followed by a total dissection up to the laryn­ geal entrance. Endoscopic laryngeal examinations were performed for vocal cord movements one day before surgery and postoperatively on days 1,3, and 7.Results: No abnormal vocal cord movements were detected preoperatively. Following surgery, none of the patients developed persistent RLN paralysis.Two patients exhibited transient vocal cord paralysis limitation in vocal cord movements . The use of the operation microscope for RLN dissections resulted in prolongation of the operation time ranging from 15 to 40 minutes for each side, which tended to decrease with enhanced experience of the surgeon.Conclusion: The use of the operation microscope enables safe RLN dissections during thyroidectomy operations.
Keywords:

Parathyroidectomy, recurrent laryngeal nerve/ anatomy & histology/injuries, thyroid diseases/surgery, thy­roid gland/blood supply, thyroidectomy,

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The Turkish Journal of Ear Nose and Throat-Cover
  • ISSN: 2602-4837
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1991
  • Yayıncı: İstanbul Üniversitesi
Arşiv
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Sinan KOCATÜRK, Ünsal ERKAM