反回神経切除症例に対する音声再建の有用性

Abstract

Our treatment of choice in voice reconstruction for recurrent laryngeal nerve (RLN) resection is concurrent nerve reconstruction. If this is not possible, we secondarily inject fat. We studied postoperative voice function and the feasibility of this voice reconstruction treatment strategy. Subjects were 39 patients with advanced thyroid cancer having the primary lesion resected together with RLN between 2001 and 2007. Of these 39, 9 underwent concurrent reconstruction by directly anastomosing the ansa cervicalis to the peripheral RLN. Fat was secondarily injected in 25 and 5 did not undergo any reconstruction. We found that: 1) Postoperative maximum phonation time (MPT), mean flow rate (MFR) and pitch perturbation quotient (PPQ) in the direct anastomosis group were significantly better than in the nonreconstruction group (p < 0.05). 2) Postoperative MPT, MFR, and PPQ in the fat injection group were significantly better than in the nonreconstruction group (p < 0.05). 3) MPT in the fat injection group was significantly better than in the direct anastomosis group one month postoperatively (p = 0.007), although this finding was reversed six months postoperatively (p = 0.08). 4) MFR in the fat injection group tended to be better than the direct anastomosis group one month postoperatively (p = 0.1), although this finding was reversed six months postoperatively (p = 0.1). We thus recommend concurrent voice reconstruction by direct anastomosis in conjuction with nerve resection.